Summary & Overview

HCPCS G9967: Children Not Screened for Developmental/Behavioral Risk

HCPCS Level II code G9967 documents encounters in which children were not screened for risk of developmental, behavioral, and social delays using a standardized tool with interpretation and report. As a place-holder code reflecting absence of screening, it carries importance for quality measurement, care coordination, and documentation standards across pediatric and primary care settings nationwide. Accurate use affects clinical records, performance measurement, and potential follow-up workflows.

Key payers in this national analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of how this code is used in practice, implications for quality reporting and administrative tracking, and the clinical context around developmental and behavioral screening in children. The publication summarizes common billing and documentation patterns, discusses where this code fits within pediatric preventive care workflows, and highlights areas where payers and providers commonly align or differ on documentation expectations.

The report does not provide clinical guidance or recommendations. It focuses on benchmarks and policy-relevant context for payers and provider organizations, including frequency of use where available, reporting considerations, and operational implications for ambulatory pediatric care.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG9967HCPCS Level IIdevelopmental screeningpediatric preventive carequality measurementambulatory carebehavioral healthdocumentation

Billing Code Overview

HCPCS Level II code G9967 denotes children who were not screened for risk of developmental, behavioral and social delays using a standardized tool with interpretation and report. This entry documents the absence of a standardized developmental-behavioral screening and interpretation during the encounter.

Service type: Developmental/behavioral risk screening (not performed)
Typical site of service: Pediatric outpatient visits, primary care clinics, and other ambulatory care settings where child developmental screening is routinely performed

Clinical & Coding Specifications

Clinical Context

A 15-month-old child presents for a well-child visit at a primary care pediatric clinic. The clinician completes the visit but a standardized developmental screening tool (for example, Ages and Stages Questionnaire or PEDS) was not administered, scored, or documented; no interpretation or written report of screening results exists in the medical record. The typical workflow for a well-child encounter includes vital signs, growth measurements, parental history, anticipatory guidance, and standardized developmental screening with tool administration, interpretation, and documentation. For this scenario, the clinician documents developmental concerns in the visit note verbally but does not complete a standardized instrument, resulting in billing with G9967 to indicate children who were not screened for risk of developmental, behavioral and social delays using a standardized tool with interpretation and report. Typical site of service is an outpatient pediatric clinic, family medicine clinic, or community health center during preventive care visits. Common modifiers may be appended to indicate unusual circumstances such as increased procedural services (22), unusual anesthesia or unplanned events, or location/modifier specifics when required by payors.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when additional physician work beyond the typical service is documented and justified (e.g., extended counseling during the visit when screening was omitted but extensive assessment was provided).
`23`	Unusual anesthesia	Use if general anesthesia was administered for unrelated procedures during the visit (rare for this code).
`52`	Reduced services	Use when the service was partially reduced or only partially performed relative to full standard.
`53`	Discontinued procedure	Use when the visit was started but screening process was stopped due to patient intolerance or emergency.
`54`	Surgical care only	Generally not applicable but can be present if billing systems require separation of services for concurrent surgical episodes.
`55`	Postoperative management only	Generally not applicable but included when postoperative care is billed separately in the encounter.
`56`	Preoperative management only	Rarely applicable; used if preoperative evaluation occurs in same visit without screening.
`62`	Two surgeons	Not typical for this preventive-service code; used when two qualified practitioners share work.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery	Not applicable to screening but included when non-physician participation needs to be specified.
`CQ`	Service furnished by an allied health professional eligible for Medicare payment under a Medicare Part B benefit (non-physician)	Use when a qualified allied health professional documents that the screening was not performed.
`QK`	Medical direction of two, three, or four qualified individuals	Use when a supervising physician directs multiple individuals performing care in the visit.
`QX`	CRNA service with medical direction	Rare for this code but used when anesthesia involvement is documented.
`QY`	Medical direction of one CRNA by an anesthesiologist	Rare for this code; appended only if anesthesia services are involved.

Taxonomy Code	Specialty	Notes
`208000000X`	Pediatrics	Primary specialty performing developmental screening during well-child visits.
`208000000P`	Family Medicine	Family physicians commonly perform developmental surveillance and screening.
`363L00000X`	Nurse Practitioner	Advanced practice providers frequently administer and interpret developmental screens.
`103T00000X`	Clinical Social Worker	May perform developmental/behavioral screening or coordinate follow-up for delays.
`207Q00000X`	Pediatric Psychiatry	Consults when developmental or behavioral concerns are identified; may be involved in follow-up assessment.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`R62.0`	Delayed milestone in childhood	Commonly associated when developmental delay is suspected and screening should be performed.
`Z00.129`	Encounter for routine child health examination without abnormal findings	Well-child visit code where developmental screening is expected; absence of a standardized screen can be reported with `G9967`.
`Z00.121`	Encounter for routine child health examination with abnormal findings	Used when screening or clinical assessment reveals concerns; if standardized screening not done, `G9967` documents omission.
`F98.0`	Nonorganic enuresis of childhood	Behavioral or developmental concerns that may prompt screening for broader developmental or social delays.
`F90.9`	Attention-deficit hyperactivity disorder, unspecified	Behavioral concerns identified in primary care that often trigger standardized developmental/behavioral screening.
`Z71.9`	Counseling, unspecified	May be used when counseling occurred in lieu of standardized screening during the visit.
`R63.3`	Feeding difficulties and mismanagement	Feeding concerns often overlap with developmental surveillance and warrant formal screening.
`Z13.31`	Encounter for screening for psychological development of child	Directly related to developmental screening activities; absence of documented standardized screening is captured by `G9967`.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99381`	Initial comprehensive preventive medicine evaluation and management of an individual, infant through 4 years	Performed for new patients where standardized developmental screening is typically included; omission of screening may be documented and billed with `G9967`.
`99391`	Periodic comprehensive preventive medicine reevaluation and management of an individual, infant through 4 years	Used for established patient well-child visits where a standardized screening would normally occur.
`96127`	Brief emotional/behavioral assessment (e.g., depression inventory, ADHD scale), with scoring and documentation, per standardized instrument	Represents standardized screening tools with scoring and report; if not performed, `G9967` indicates absence of such a standardized instrument.
`96110`	Developmental screening test, with interpretation and report (e.g., Denver II, Bayley), first hour	Historically used for more extensive developmental testing and formalized interpretation; complements or follows screening when concerns are detected.
`99420`	Administration and interpretation of health risk assessment instrument (e.g., health risk assessment)	Related to standardized assessments and documentation workflows; not specific to developmental screening but similar in process and reporting.