CPT Code 96112 is a key billing code for healthcare providers specializing in developmental and behavioral health. Understanding and correctly billing for  CPT Code 96112 is vital for professionals who conduct these specialized evaluations.

This article aims to demystify the billing process associated with CPT Code 96112, providing clear and straightforward guidance to ensure accurate and efficient billing practices..

Article Index

• Description
• Time Frame
• Reimbursement Rate
• How to Bill
• Guidelines

CPT Code 96112 Description

CPT Code 96112 is used for developmental test administration by healthcare professionals. This code encompasses a range of evaluations essential for diagnosing developmental delays and behavioral disorders in patients. These tests often include assessments of cognitive, motor, communication, and social skills.

The role of developmental testing in behavioral health is significant. It allows for a structured approach to identifying and understanding various developmental issues, forming the basis for effective treatment plans. This code is integral in ensuring that developmental assessments are conducted thoroughly and billed appropriately. (Source)

Time Frame for CPT Code 96112: 30-60 Minutes

The typical duration for services billed varies, generally ranging from 30 minutes to an hour. This time frame reflects the comprehensive nature of developmental tests, which require detailed evaluation.

In billing, the duration of these tests directly influences reimbursement. Accurate time recording is crucial for ensuring services are appropriately reimbursed.

CPT Code 96112 Reimbursement Rate: $121.81

Reimbursement rates have seen changes over recent years:

• 2024 Rate: In 2024, the rate for 96112 is set at $121.81, reflecting the current valuation for these specialized services.
• 2023 Rate: The previous year, 2023, saw a slightly higher rate at $126.74.
• 2022 Rate: In 2022, the reimbursement was at $141.02, indicating a gradual decrease over these years.

These rates, determined by Medicare, are subject to change due to healthcare policy adjustments and economic factors. For the most accurate and up-to-date information, healthcare providers should consult the Centers for Medicare & Medicaid Services (CMS) website or relevant government resources.(Source)

Streamlined Approach to Billing 96112

• Document Thoroughly: Begin by meticulously documenting the developmental testing session, noting the duration, specific tests conducted, and any observations.
• Code Correctly: Use 96112 for the first hour of developmental test administration. If the session extends beyond an hour, remember to use additional codes as necessary.
• Submit with Precision: When submitting the claim, ensure that all documentation supports the use of CPT Code 96112. Clear and precise claims are less likely to face delays or denials.
• Pro Tip: Regularly update your knowledge on billing practices for developmental testing. Staying informed helps avoid common pitfalls and streamlines the billing process.

Key Guidelines for Billing

• Reserve 96112 for the first hour of developmental testing. This includes a variety of assessments crucial for diagnosing developmental delays and behavioral issues.
• Keep detailed records of each testing session, including the types of tests administered, the duration, and the results. Clear documentation is vital for compliance and reimbursement.
• Familiarize yourself with the specific insurance requirements for developmental testing. Different policies may have unique coverage stipulations for 96112.
• Regularly check for updates in coding guidelines and insurance policies related to developmental testing to ensure ongoing compliance and accurate billing. (Source)

Eligibility for Billing 96112

CPT Code 96112 is typically billed by healthcare professionals specialized in developmental and behavioral health, including psychologists, pediatricians, and other qualified practitioners trained in developmental testing.

Regulatory Compliance

Regulatory Compliance: Professionals must adhere to both state licensing standards and federal regulations relevant to their practice. It’s crucial to ensure that your qualifications align with the requirements for administering and billing developmental tests.

Staying abreast of these requirements is key to successful and compliant billing for developmental testing services.

Seeking expert assistance in navigating these billing processes?

Don’t hesitate to contact us for specialized billing service. We’re here to ensure your billing is efficient and compliant.