Summary & Overview

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.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 96113developmental testingpediatric assessmentbehavioral health billingpsychological testingambulatory servicestime-based coding

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.

Service type: Developmental and psychological testing, extended administration and interpretation
Typical site of service: Outpatient clinic, behavioral health center, pediatric specialty clinic, or other ambulatory settings where developmental assessments are performed

Clinical & Coding Specifications

Clinical Context

A 5-year-old child is referred by a pediatrician to a developmental-behavioral pediatrician or licensed psychologist because of concerns about delayed language, social interaction, and play skills. The provider performs a comprehensive battery of standardized developmental and cognitive tests during a scheduled testing session. The initial battery is billed with the primary code 96112 for the first 30 minutes of testing. Because testing requires extended time, an additional 30-minute block of test administration is billed using 96113. The clinician administers age-appropriate measures (for example, standardized cognitive scales, language assessments, and adaptive behavior questionnaires), observes the child’s performance, scores the instruments, interprets results in the context of developmental history and medical/educational records, and documents findings in a formal report. The typical workflow includes caregiver interview, test administration (multiple subtests), scoring, interpretation, and preparation of a written report summarizing results and recommendations. Typical sites of service are outpatient behavioral health clinics, developmental pediatrics clinics, hospital outpatient departments, and specialized neuropsychology or psychology practices.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component

Taxonomy Code	Specialty	Notes
`103K00000X`	Child and Adolescent Psychiatrist	Psychiatrists who perform developmental diagnostic evaluations and interpret testing
`103T00000X`	Developmental-Behavioral Pediatrician	Pediatricians specializing in developmental assessments and diagnosis
`182L00000X`	Clinical Psychologist	Psychologists who administer and interpret standardized developmental and cognitive tests
`234K00000X`	Neuropsychologist	Specialists who perform comprehensive neuropsychological testing and interpret cognitive profiles
`367A00000X`	Speech-Language Pathologist	SLPs who administer language and communication assessments as part of a multidisciplinary evaluation

ICD-10 Code	Description	Clinical Relevance
`F80.0`	Phonological disorder	Language testing identifies articulation and expressive language deficits relevant to developmental testing
`F80.1`	Expressive language disorder	Common indication for comprehensive language and developmental assessment
`F80.2`	Receptive language disorder	Testing evaluates comprehension and receptive language delays
`F84.0`	Autism spectrum disorder	Standardized developmental and social communication assessments are central to ASD diagnosis
`F81.9`	Developmental disorder of scholastic skills, unspecified	Cognitive and achievement testing may be used to identify learning-related developmental delays
`F81.2`	Mixed disorder of scholastic skills	Evaluations identify patterns of cognitive strengths and weaknesses affecting learning
`R62.0`	Delayed milestone in childhood	General developmental delay code commonly paired with comprehensive developmental testing
`F90.0`	Attention-deficit hyperactivity disorder, predominantly inattentive type	Testing may be part of multidisciplinary evaluation when attentional or executive function concerns are present

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`96112`	Neurobehavioral status exam, by physician or other qualified health care professional, first 30 minutes of a resident or caregiver interview, test administration, and scoring	Primary code for the first 30 minutes of standardized developmental or neurobehavioral testing; `96113` is reported for each additional 30 minutes
`96130`	Psychological testing evaluation services by physician or qualified healthcare professional, first 30 minutes	Alternative code set used for psychological testing evaluation services; may be used when testing is diagnostic and billed under the psychological testing series rather than neurobehavioral status
`96136`	Psychological or neuropsychological test administration and scoring by technician, first 30 minutes	Used when a technician administers and scores portions of testing under supervision; supports billing coordination when multiple personnel are involved
`96138`	Psychological or neuropsychological test administration and scoring by physician or qualified health care professional, first 30 minutes	For direct administration and scoring by the qualified professional; may be used in conjunction with interpretation codes
`99454`	Device(s) supply with daily recordings or programmed alerts transmission, each 30 days	Occasionally relevant when remote or device-assisted assessment tools provide supplemental data (use only if payer accepts)
`96127`	Brief emotional/behavioral assessment (e.g., depression inventory, ADHD scale), with scoring and documentation, per standardized instrument	Used to bill short, focused screening instruments that complement the comprehensive testing battery

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