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CPT 96113: Developmental Testing, Additional 30 Minutes
CPT code 96113 denotes additional time for administration and interpretation of standardized developmental tests in children, billed in 30-minute increments beyond the primary testing service (96112). This code is important nationally because developmental assessments inform diagnoses, care planning, early intervention services, and authorization decisions across pediatrics and behavioral health. Key payers examined include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of how the code is defined and used in clinical settings, typical sites of service, common billing modifiers, and payer coverage patterns. The publication highlights benchmarks for utilization and reimbursement, recent policy clarifications that affect billing and documentation, and clinical context for when extended testing time is clinically appropriate. The analysis also outlines operational considerations for coding workflows and documentation to support claims for additional testing time. Data not available in the input is noted where relevant.
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Billing Code Overview
CPT code 96113 covers the administration and interpretation of standardized diagnostic tests used to evaluate developmental problems in children. The service involves conducting structured, validated assessment instruments, interpreting the results, and preparing a written report. CPT code 96113 is reported for each additional 30 minutes of test administration beyond the primary procedure coded with 96112.
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Service type: Developmental and psychological testing, extended administration and interpretation
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Typical site of service: Outpatient clinic, behavioral health center, pediatric specialty clinic, or other ambulatory settings where developmental assessments are performed