Developmental Screening in the First 3 Years Tip Sheet

Incentives will be paid on an annual basis, following the end of Quarter 4. For additional information, refer to the CBI Technical Specifications.

Documentation must include a standardized developmental screening tool. Screening tools do not need to be sent to the Alliance. Developmental screenings are recommended at the 9, 18, and 30-month visits following the Bright Futures periodicity schedule. Developmental concerns found through developmental surveillance should be followed by standardized developmental screening or direct referral to intervention and specialty care and be documented for medical necessity in the chart. 

Please make sure the following are in the patient’s medical record:

• Indication of the standardized tool that was used.
• The date of the screening, and evidence that the tool was completed and scored.

Refer to the chart below for examples of standardized screening tools.

Note: The following domains must be included in the standardized developmental screening tool: motor (fine and gross), language, cognitive, and social-emotional with established reliability, validity and sensitivity/specificity ratings of 0.70 and above.

Standardized tools that specifically focus on one domain of development (e.g. child’s social emotional development [ASQ-SE] or autism [M-CHAT}) do not qualify as screening tools that identify risk of developmental, behavioral, and social delays.

Developmental testing, with interpretation and report CPT Code: 96110.

Billing Frequency: Twice in a 12-month period.

If additional screenings are performed for the screening of autism, bill the CPT 96110 with the modifier KX, and it won’t count toward the twice yearly allowable. Autism screening tools like MCHAT alone does not count as developmental screening, nor does standardized screening for a specific domain of development such as social emotional screening via the ASQ-SE.

Billing Frequency: Twice in a 12-month period.

Data for this measure will be collected using claims, DHCS Fee-for-Service encounter claims, and provider data submissions via the Data Submission Tool (DST) on the Provider Portal. To find gaps in data:

• Run a report from your Electronic Health Record (EHR) system; or
• Manually compile patient data (Example: Download your Care-Based Incentives Measure Details report on the Provider Portal and compare to your EHR/paper charts).

This measure allows providers to submit developmental screening information from the clinic EHR system or paper records to the Alliance by the DST contractual deadline. To submit, you may upload data files to the DST on the Provider Portal. To be accepted, data must be submitted as a CSV file. Step-by-step instructions are available in the Data Submission Tool Guide on the Provider Portal.

• Incorporate screening procedures into the ongoing healthcare of children. This increases the chances that previously undetected developmental delays can be picked up at subsequent screenings (American Academy of Pediatrics, AAP)[i].
• Conduct developmental surveillance at every health visit and screen using a formal, validated tool at age 9, 18 and 30 months (AAP). When discussing developmental surveillance with families, using the term “monitoring” may be a more helpful way of discussing surveillance.
• Screen more frequently if there are additional risk factors, such as preterm birth, low birth weight and lead exposure, among others.
• Elicit and attend to parent concerns about their child’s development.
• Screen for maternal depression at 1, 2, 4, and 6-month visits. Postpartum depression is considered an adverse childhood experience and has a profound effect on infants and children[ii].
• Survey parents/guardians for risk factors of social determinants (e.g. food, housing, etc.) of health at all patient visits.
• Social-emotional screening is recommended at regular intervals.

[i] American Academy of Pediatrics. Developmental Surveillance and Screening of Infants and Young Children Committee on Children with Disabilities. (2001). American Academy of Pediatrics, 108 (1), 192-195. https://pediatrics.aappublications.org/content/108/1/192

[ii]Incorporating Recognition and Management of Perinatal Depression Into Pediatric Practice
Earls, MF, Yogman, MW, Mattson, G, Rafferty, J. Committee on psychosocial aspects of child and family health. (2019). American Academy of Pediatrics, 143(1). https://publications.aap.org/pediatrics/article/143/1/e20183259/37241/Incorporating-Recognition-and-Management-of

An example workflow can include the following:

• Alliance interpreting services are available to network providers:
  • Telephonic interpreting services are available to assist in scheduling members.
  • Face-to-face interpreters can be requested to be at the appointment with the member.

  For information about our Cultural and Linguistic Services Program, please call the Alliance Health Education Line at 800-700-3874, ext. 5580 or email us at [email protected].

• Refer patients who have transportation challenges to the Alliance’s Transportation Coordinator at 800-700-3874, ext. 5577. This service is not covered for non-medical locations or for appointments that are not medically necessary.
• Promoting Optimal Development: Identifying Infants and Young Children With Developmental Disorders Through Developmental Surveillance and Screening.
• Identification, Evaluation, and Management of Children With Autism Spectrum Disorder.
• Developmental Surveillance: What, Why and How.
• AAP’s Identify Risks, Strengths, and Protective Factors for Children and Families: A Resource for Clinicians Conducting Developmental Surveillance.