Summary & Overview
CPT 96112: Developmental Testing and Interpretation, First Hour
CPT code 96112 covers the administration, interpretation, and reporting of standardized developmental tests for children for the first hour of testing. This code captures work performed by clinicians who evaluate developmental concerns—such as delays in speech, motor skills, social interaction, or adaptive functioning—and produce an interpretive report that informs diagnostic and care planning decisions. Nationally, use of formal developmental testing is a key component of pediatric and behavioral health services and affects access to early intervention and specialty care.
Key payers covered in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the code’s clinical context, typical sites of service, common modifiers and billing considerations, and how 96112 relates to other assessment services. The publication also provides benchmarking and policy update highlights where available, along with practical coding notes that clarify when to report this code for the first hour of test administration. This summary is intended for clinicians, billing professionals, and policy analysts seeking a national-level reference on the use and implications of CPT code 96112.
Billing Code Overview
CPT code 96112 describes administration and interpretation of standardized developmental tests to diagnose developmental problems in children. The service covers the provider's administration of one or more standardized instruments, interpretation of the results, and preparation of a report for the first hour of test administration.
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Service type: Developmental testing and assessment
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Typical site of service: Outpatient clinic, pediatric specialty clinic, developmental-behavioral pediatrics, or other ambulatory care settings where behavioral and developmental assessments are delivered
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Clinical & Coding Specifications
Clinical Context
A 4-year-old child is referred by a pediatrician to a developmental-behavioral pediatrician or licensed psychologist because of concerns about delays in speech, social interaction, and irregular play skills. The child arrives at an outpatient clinic or specialized developmental assessment center accompanied by a caregiver. The provider administers standardized developmental and cognitive tests (for example, age-appropriate measures of language, cognition, motor skills, and adaptive behavior) using structured one-on-one test sessions. The initial testing session lasts up to one hour and includes test administration, observation of behavior during tasks, and collection of caregiver history relevant to developmental milestones. After administration, the clinician scores and interprets results, integrates findings with history and observations, and prepares a formal written report documenting raw scores, standardized scores, interpretation, diagnostic impressions, and recommended interventions or referrals. Typical sites of service are outpatient clinics, hospital ambulatory departments, or specialty developmental centers. This encounter is billed using 96112 for the first hour of test administration and interpretation with preparation of the report, with additional time billed per applicable codes if extended beyond the first hour.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management (E/M) service by the same physician on the same day of the procedure or other service |