Receiving reimbursement for the AIMS assessment
Amalgam Rx
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The AIMS assessment is a qualitative tool for diagnosing and monitoring involuntary movements caused by antipsychotic medications. Learn how some practices are billing for this assessment to learn how you might receive reimbursement for your practice.
Even with the advancements made with atypical antipsychotics, drug-induced movement disorders (DIMD), like tardive dyskinesia (TD), can still be a challenging side effect for many patients. Proper diagnosis and ongoing monitoring are essential for finding the right medication balance for each patient and avoiding the chance of persistent—or even permanent—DIMDs.
The abnormal involuntary movement scale (AIMS) is a qualitative assessment to diagnose and track the presence of DIMDs, and it is the standard of care recommended by The American Psychological Association (APA).
This head-to-toe overview captures any indicative movements a patient might be demonstrating, such as excessive blinking, abnormal jaw movements, shaking, tremors, stiffness, or difficulty controlling their arms or legs.
In March 2024, Amalgam Rx conducted 30 in-depth interviews with healthcare providers to better understand the experiences of clinicians with this particular class of drugs and the AIMS assessment. Among many interesting learnings uncovered during these interviews, the ways in which some clinics get reimbursement for AIMS stood out as noteworthy.
Watch our Becker’s webinar that includes best practices for AIMS reimbursement billing.
How some clinicians bill for AIMS
According to the clinicians we interviewed, their preferred billing code for conducting AIMS is CPT 96127, defined as an add-on code intended for a “Brief emotional/behavioral assessment…with scoring and documentation, per standardized instrument.”
Note: Please consult a qualified billing professional before using this code to make sure it’s appropriate for your workflow and avoid double-billings.
It seems that incorporating the AIMS assessment as part of a routine workflow may be an important step in maintaining an accurate billing process. To this point, Dr. Jordan Howard, a board-certified psychiatrist in Alpharetta, Georgia, stated in an AIMS webinar hosted by Amalgam Rx: “Just like any other workup we may do, we want to incorporate the AIMS into our billing workflow.”
Billing considerations for CPT 96127
To ensure reimbursement when using CPT 96127, some clinicians recommend first considering the following questions:
Who conducts the assessment?
The AIMS assessment should be provided and scored by a trained doctor, nurse, medical assistants, behavioral health technicians, or other qualified health professional (QHP) within both psychiatric and primary care settings.
According to a 2017 article from the American Academy of Family Physicians (AAFP), the assessments do not have to be conducted by a doctor to qualify for reimbursement. The article states:
“These codes do not represent physician work. For payment purposes, each screening and assessment code [is] valued based on practice expense and professional liability only, which includes the cost of furnishing instruments (when applicable) and staff time to administer and/or score an instrument for the physician or other qualified health care professional's review.”
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The same article further clarifies that there is no physician work value published on the Medicare physician fee schedule, “Because clinical staff typically performs the 96127 service, the Medicare RBRVS relative values reflect only the practice expense (clinical staff time, medical supplies, medical equipment) and professional liability insurance.”
To be clear, reimbursement is still possible when physicians conduct the assessment. The “Coding for Standardized Assessment, Screening, and Testing” fact sheet provided by the American Academy of Pediatrics (AAP) states: “On the less common occasion where a physician performs this service, it may still be reported with code 96127, but only the ordering would count under the data point for MDM. Do not include the time spent administering the test in the time for the E/M service.”
It’s worth noting again that you should consult with a billing expert for specific guidance on whether or not this code is appropriate for your practice, how it should be reported, and if you should include any modifiers.
What documentation is required?
When filing CPT 96127, it’s important to verify your payers' documentation requirements prior to providing these services.
Based on CMS criteria and the previously mentioned AAFP article, documentation requirements include:
How long should the assessment take?
There is no designated time length requirement for CPT 96127, and reimbursement is unaffected by the amount of time used. Each assessment and subsequent scoring can vary in length but often takes about 15 minutes to complete.
The AAP fact sheet states this overtly by saying, “Do not include the time spent administering the test in the time for the E/M service.”
Is it a virtual AIMS assessment?
Medicare considers CPT 96127 as “telehealth eligible,” which means they reimburse healthcare providers for conducting AIMS virtually. In general, other insurers often do the same, but it’s advisable to confirm this with carriers before billing.
In the Becker’s webinar about best practices for conducting the AIMS, Dr. Howard told Amalgam Rx that virtual assessments are possible and can be billed using the same CPT code. However, he does not recommend conducting AIMS exclusively through telehealth. Rather, the assessment can be done virtually (if needed) in conjunction with in-person assessments as part of an overall strategy for diagnosing and tracking DIMDs.
Other best practices for AIMS
Beyond billing for AIMS, the clinicians we spoke to shared other best practices that may help make the assessment the standard of care at your organization.
Visit Amalgam Rx.com/AIMS to learn more about how your organization can receive reimbursement for supporting a vulnerable patient population with the AIMS assessment.
Physical Medicine & Rehabilitation / Spinal Cord Injury Medicine | Certified Independent Medical Examiner | Principal Partner at Lea Medical Partners LLC
3moI use the AIMS evaluation regularly in my practice. It has become an invaluable tool not only for diagnosis but to show validity in my notes for what have become complex reimbursement guidelines. Showing a history of patient progress in documentation is key when managing appeals. Using AI in practice pre appeal is key to prevention of financial leaks.