CurrentBlue Cross Blue Shield of VermontPolicy 3.01.VT203

Pediatric Neurodevelopmental and Autism Spectrum Disorder (ASD) Screening Corporate Medical Policy

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This policy governs coverage of standardized developmental and autism spectrum disorder screening for pediatric members, including applicable provider, documentation, and medical-necessity requirements. It applies to qualified healthcare professionals providing screening within the scope of their licenses; comprehensive developmental or ASD evaluations are addressed separately.

Policy Summary

PayerBlue Cross Blue Shield of Vermont

PolicyPediatric Neurodevelopmental and Autism Spectrum Disorder (ASD) Screening

Policy CodePolicy 3.01.VT203

Change TypeClarified and revised

Effective DateDecember 1, 2026

Last ReviewJul 1, 2026

Next Review DateAugust 1, 2027

Key ActionDocument use of one or more standardized screening tools in the clinical notes and medical record when billing code 96110.

SourceLink

POLICY UPDATE CHANGES

The August 2026 policy review clarified when pediatric screening services are medically necessary, not medically necessary, and subject to prior authorization.

The policy was revised to state that code 96110 developmental screening is covered without prior authorization when performed by a qualified healthcare professional using a standardized screening tool and documented in the medical record.

9, 18, 30 monthsRecommended developmental screening ages under EPSDT guidelines

18 and 24 monthsRecommended autism screening ages under EPSDT guidelines

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CurrentBlue Cross Blue Shield of VermontPolicy 3.01.VT203

Pediatric Neurodevelopmental and Autism Spectrum Disorder (ASD) Screening Corporate Medical Policy

Customize your policy alerts

Sign up for bcbsvermont Policy 3.01.VT203 alerts

Get alerted when Policy 3.01.VT203 changes without checking for updates manually.

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Policy Summary

PayerBlue Cross Blue Shield of Vermont

PolicyPediatric Neurodevelopmental and Autism Spectrum Disorder (ASD) Screening

Policy CodePolicy 3.01.VT203

Change TypeClarified and revised

Effective DateDecember 1, 2026

Last ReviewJul 1, 2026

Next Review DateAugust 1, 2027

Key ActionDocument use of one or more standardized screening tools in the clinical notes and medical record when billing code 96110.

SourceLink

POLICY UPDATE CHANGES

The August 2026 policy review clarified when pediatric screening services are medically necessary, not medically necessary, and subject to prior authorization.

9, 18, 30 monthsRecommended developmental screening ages under EPSDT guidelines

18 and 24 monthsRecommended autism screening ages under EPSDT guidelines

96110Covered developmental screening code identified by the policy

No prior authorizationRequirement for covered code 96110 screening under the stated criteria

1 explicit exclusionScreening without an accepted standardized validated tool is not medically necessary

Medical Necessity and Coverage Scope

Medically Necessary Developmental Screening

Code 96110 developmental screening is covered when ALL of the following requirements are met:

ALL of the following

The service is developmental screening billed with code 96110.
The screening is performed by a qualified healthcare professional practicing within the scope of the professional's license(s).
The screening utilizes an accepted, validated, standardized developmental or autism spectrum disorder (ASD) screening tool, including one or more of the following: Ages and Stages Questionnaires (ASQ-3); Battelle Developmental Inventory Screening (BDI-2 or BDI-3); Bayley Infant Neurodevelopmental Screen (BINS); Child Development Inventory (CDI); Parent's Evaluation of Developmental Status (PEDS); or Modified Checklist for Autism in Toddlers (M-CHAT or M-CHAT-R/F).
Use of the standardized screening tool is documented in the medical record, and clinical notes are submitted for the service.
Prior authorization is not required for the covered developmental screening service.
A specific diagnosis is not required.

This policy applies to screening for pediatric development and autism spectrum disorders (ASD) consistent with the 2017 Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) guidelines. It applies to screening only and does not apply to intensive developmental or neurodevelopmental evaluation. This level of screening requires established standardized testing, such as the Ages and Stages evaluation, and entails more than the traditional developmental survey in which a pediatric provider asks a few questions about the child's physical, social, and intellectual development.

Pediatric neurodevelopmental and ASD screening is not medically necessary when an accepted, validated, standardized screening tool is not utilized.

Covered and Applicable Procedure Codes

Covered CPT CodesCPTCovered

96110

Developmental testing: limited (e.g., Developmental Screening Test II, Early Language Milestone Screen), with interpretation and report; developmental screening (e.g. developmental milestone survey, speech, and language delay screen), with scoring and documentation, per standardized instrument

Developmental Test AdministrationCPT

96112	Developmental test administration (including assessment of fine and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified health care professional, with interpretation and report; first hour
96113	Developmental test administration (including assessment of fine and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified health care professional, with interpretation and report; each additional 30 minutes (List separately in addition to code for primary procedure)

Authorization, Documentation, and Denial Risks

Prior Authorization

96110: No Prior Authorization When Criteria Are Met

Code 96110 developmental screening is covered without prior authorization when the applicable medical-necessity criteria are met. The service must be performed by a qualified healthcare professional within the scope of their license and must include standardized screening, scoring, and documentation.

CPT 96110: No prior authorization required when applicable criteria are met.
Use an accepted, validated standardized screening tool and document the results in the medical record.

Prior Authorization

96112 and 96113: Authorization Removed

Prior authorization was removed for developmental testing codes 96112 and 96113 in the August 2026 policy update. Providers must still meet the applicable coverage and documentation requirements.

CPT 96112 and 96113: Prior authorization is not required effective with the August 2026 update.
The removal of authorization does not eliminate medical-necessity or documentation requirements.

Screening Schedule Context

EPSDT guidelines recommend developmental screening at 9, 18, and 30 months and autism screening at 18 and 24 months. Screening may also be appropriate outside these recommended ages when clinically indicated.

Screening Terminology

Pediatric developmental and ASD screening

Policy screening conceptPediatric developmental and autism spectrum disorder (ASD) screening requires standardized, established testing.

ScopeThe screening is intended to identify developmental or ASD concerns and is distinct from intensive developmental or neurodevelopmental evaluation.

Difference from traditional surveyIt is more comprehensive than a traditional developmental survey consisting of a few questions about the child’s physical, social, and intellectual development.

Standardized screening tool

DefinitionA validated instrument used to identify children who may need further developmental or autism spectrum disorder evaluation.

Use under this policyThe screening tool must be used during the screening and identified in the clinical notes and medical record.

Policy Summary

PayerBlue Cross Blue Shield of Vermont

PolicyPediatric Neurodevelopmental and Autism Spectrum Disorder (ASD) Screening

Policy CodePolicy 3.01.VT203

Change TypeClarified and revised

Effective DateDecember 1, 2026

Last ReviewJul 1, 2026

Next Review DateAugust 1, 2027

Key ActionDocument use of one or more standardized screening tools in the clinical notes and medical record when billing code 96110.

SourceLink

On This Page

Documentation Required

Use and Document a Standardized Screening Tool

Before billing, use an accepted standardized developmental or autism screening instrument and submit clinical notes identifying one or more tools used. Retain the screening documentation in the patient’s medical record.

Examples include ASQ-3, BDI-2/BDI-3, BINS, CDI, PEDS, and M-CHAT/M-CHAT-R/F.
Clinical notes must include the screening tool or tools used.
Document the screening and results in the medical record and retain the records.

Note

Diagnosis Not Required

A specific diagnosis is not required for developmental screening. Coverage still depends on use of a standardized screening tool and documentation in the medical record.

Do not deny or defer the screening solely because no specific diagnosis has been established.

Denial Risk

No Standardized Validated Screening Tool

Pediatric neurodevelopmental and ASD screening is not medically necessary when an accepted, validated standardized screening tool is not used. A general developmental survey or a few informal questions does not satisfy the policy’s screening requirement.

Use an accepted, validated tool such as ASQ-3, BDI, BINS, CDI, PEDS, or M-CHAT/M-CHAT-R/F.
Failure to use a standardized validated tool may result in denial as not medically necessary.

Documentation Required

Missing Screening Documentation Creates Denial Risk

Maintain complete medical-record and clinical-note documentation for the screening. The record must identify the standardized tool or tools used, support scoring and results, and include the information submitted with the claim.

Clinical notes must be submitted for the service.
The medical record must document use of the standardized screening tool and screening results.
Missing required documentation creates a denial risk even when no specific diagnosis is required.

Denial Risk

Stay Within the Screening Scope

This policy covers standardized pediatric developmental and ASD screening, not intensive or comprehensive developmental or neurodevelopmental evaluation. When screening indicates a need for more comprehensive evaluation, direct the request to the applicable separate Blue Cross VT Corporate Medical Policy on Neuropsychological and Psychological Testing.

Do not bill intensive or comprehensive evaluation services as routine screening under this policy.
Additional testing may be subject to the separate Neuropsychological and Psychological Testing policy.

ExamplesExamples include the Ages and Stages Questionnaires (ASQ-3), Battelle Developmental Inventory Screening (BDI-2 or BDI-3), Bayley Infant Neurodevelopmental Screen (BINS), Child Development Inventory (CDI), PEDS, and M-CHAT or M-CHAT-R/F.