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Developmental Screening and Autism Spectrum Screening

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Developmental screenings that utilize a standardized test can be billable using CPT code 96110. This service is reimbursable in accordance with Bright Futures periodicity table. A validated screening tool is required and must test all four developmental areas: motor, language, cognitive and social/emotional.

Ages: 9, 18 and 30 months. 

Validated tools: ASQ-3, PEDS, PEDS-DM, SWYC, BDI-ST, BINS, CDI. 

Frequency: twice a year (only one test administered per day). 

Autism Spectrum Disorder screenings are also reimbursable with CPT code 96110 and modifier KX and follow the Bright Futures periodicity table. The autism screening can be done during the same date as the developmental screenings with the appropriate modifier appended. 

Ages: 18 and 24 months. 

Validated tools: MCHAT. 

Frequency: twice a year (only one test administered per day). 

Modifier: KX. 

Additional information: CPT code 96110 (developmental screening, with scoring and documentation, per standardized instrument) is not reimbursable if billed within one month of code 99460 or 99462 (normal newborn care services) by the same provider for the same recipient. 

Evaluation & Management (E&M) (eval) (ca.gov) 

Preventive Services (prev) (ca.gov) 

Care-Based Incentive Developmental Screening in the First 3 Years Tip Sheet 

https://www.cdc.gov/ncbddd/childdevelopment/screening.html 

If you have any questions, please contact our Provider Services team at 800-700-3874, ext. 5504.