CPT 96110 Developmental Screening Reimbursement | OpenPayer

Summary & Overview

CPT 96110: Developmental Screening Using Standardized Instrument

CPT code 96110 covers brief, standardized developmental screening assessments that evaluate milestones and age‑appropriate speech and language skills and requires scoring and documentation by the provider. This code is nationally relevant because developmental screening is a routine element of pediatric and some adult outpatient care, supports early identification of developmental delays, and informs follow‑up diagnostic and intervention pathways.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise review of what the code represents clinically and operationally, common payer coverage patterns, and the implications for outpatient primary care and behavioral health settings. The publication outlines typical sites of service for this screening, common administrative considerations, and related billing context.

This report helps clinicians, billing staff, and policy stakeholders understand how CPT code 96110 is used in practice, what to expect from major payers nationally, and where to look for policy or coverage updates that affect developmental screening workflows and documentation requirements.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare96110CPTdevelopmental-screeningpediatricsoutpatientbehavioral-healthscreening-assessmentmedical-billing

Billing Code Overview

CPT code 96110 describes a developmental screening performed by a provider using a standardized instrument focused on developmental milestones and age‑appropriate speech and language maturity. The provider completes the screening by scoring and documenting the results on a recognized form or tool.

Service type: Developmental screening using a standardized instrument
Typical site of service: Primary care office, pediatric clinic, behavioral health clinic, or other outpatient setting where developmental surveillance and screening are performed

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A typical patient is a 15-month-old presenting for a well-child visit in a pediatric primary care clinic. The caregiver reports concerns about delayed speech and limited social engagement. The primary care pediatrician uses a standardized developmental screening tool (for example, Ages and Stages Questionnaire or Modified Checklist for Autism in Toddlers) during the visit, scores the responses, documents the results in the medical record, and discusses findings with the caregiver. If the screen is positive or borderline, the clinician documents the need for referral to early intervention services, pediatric developmental-behavioral specialist, speech-language pathology, or behavioral health. The encounter occurs in an outpatient clinic or office setting and is typically short, focused on instrument administration, scoring, interpretation, and documentation. Billing reflects the screening instrument administration and scoring rather than comprehensive developmental testing or therapeutic services.

Coding Specifications

Modifier	Description	When to Use
`25`	Significant, separately identifiable evaluation and management service by the same physician on the same day	Use when a distinct E/M visit is performed in addition to the screening during the same encounter and documented separately.
`59`

CPT 96113: Developmental Testing, Additional 30 Minutes

CPT-96112-DEVELOPMENTAL-TESTING-CHILDREN

CPT 96112: Developmental Testing and Interpretation, First Hour

Taxonomy Code	Specialty	Notes
207P00000X	Pediatrics	Primary clinicians performing routine developmental screening in well-child care.
208000000X	Family Medicine	Family physicians who perform developmental screens during pediatric visits.
2080000007	General Practice	General practitioners who provide pediatric preventive care and screening.
363L00000X	Speech-Language Pathology	Speech-language pathologists who may administer, interpret, or follow up on screening results.
103T00000X	Developmental-Behavioral Pediatrics	Specialists who evaluate positive screens and provide diagnostic assessment and management.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`R62.0`	Delayed milestone in childhood	Directly indicates developmental delay prompting use of a standardized developmental screening instrument.
`F80.0`	Phonological disorder	Speech delay concerns identified on screening may correlate with specific speech sound disorders.
`F84.0`	Autistic disorder	Screening may identify features suggestive of autism spectrum disorder requiring diagnostic referral.
`R47.9`	Speech disturbance, unspecified	Used when the screening documents speech concerns without a more specific diagnosis.
`Z00.129`	Encounter for routine child health examination without abnormal findings	Used when screening is part of a well-child visit with no abnormal findings noted.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes	Often billed on the same day when a moderate-complexity E/M is provided in addition to the screening; supports `25` modifier when appropriate.
`96127`	Brief emotional/behavioral assessment (e.g., depression inventory) with scoring and documentation, per standardized instrument	Short behavioral screening that may be used alongside developmental screening for social/emotional domains.
`92507`	Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual	May be billed subsequently if screening leads to referral and initiation of speech therapy.
`96112`	Developmental testing, with interpretation and report, first hour	Used when a more comprehensive developmental assessment is performed after a positive screen.
`99420`	Administration and interpretation of health risk assessment instrument (note: legacy code, limited use)	Occasionally used in some workflows for structured assessments; verify payor applicability.

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