CPT Code 96110 plays a pivotal role in developmental screening and testing, particularly in pediatric healthcare. This code is used for billing standardized developmental assessments essential in early detection and intervention for developmental delays in children.

This article aims to provide a clear and concise guide on effectively utilizing CPT Code 96110 in billing, offering simple instructions for healthcare professionals dedicated to pediatric care.

Article Index

• Description
• Time Frame
• Reimbursement Rate
• How to Bill
• Essential Guidelines
• Who Can Bill

CPT Code 96110 Description

CPT Code 96110 Description:  Developmental screening and testing.

This code applies to various standardized assessments that evaluate developmental milestones and identify potential delays in young children.  These screenings cover areas like language, motor skills, social interaction, and emotional development.

By identifying developmental issues early, healthcare providers can initiate timely interventions, significantly improving long-term outcomes for children.

This code ensures that practitioners can effectively bill for these vital assessments, supporting important work in pediatric care and child development. (Source)

CPT Code 96110 Time Frame: 60 Minutes

The typical duration for services billed under CPT Code 96110 is usually 60 minutes.

This time frame accommodates the administration of standard developmental screenings and assessments for children.

In billing, the length of these sessions directly impacts the reimbursement rate. Accurate documentation of the time spent is essential to ensure proper billing under 96110, aligning the services provided with the appropriate reimbursement.

If you’re wondering about coding for these cases, feel free to reach out about our mental health billing service.

CPT Code 96110 Reimbursement (2024): $11.46

It’s important to note that Medicare typically does not cover screenings under this code. Instead, for developmental testing using a standardized instrument form, healthcare providers should refer to HCPCS code G0451.

This distinction in billing and reimbursement underscores the importance of using the correct code for the specific services provided. Accurate coding ensures that healthcare professionals are reimbursed appropriately for their services and comply with Medicare guidelines.

For the most current information on reimbursement rates and billing practices, healthcare providers can consult the Centers for Medicare & Medicaid Services (CMS) website. (Source)

How to Bill CPT Code 96110

Start by thoroughly documenting the developmental screening or testing session. Include details like the date, duration, and specific assessments used. This is crucial for accurate billing.

Use CPT Code 96110 for billing. Ensure this code matches the services provided. Misalignment between services and codes is a common error that can lead to claim rejections.

Once you’ve documented and coded the service, submit the claim to the insurance provider. Ensure all the necessary information is included to avoid delays. (Source)

Avoiding Common Pitfalls

• Don’t Overlook Details: Incomplete documentation can lead to denied claims. Record every detail.
• Stay Updated: Billing codes and guidelines can change.  Keep up-to-date with the latest billing practices for 96110.
• Double-Check Your Work: A quick review before submission can catch errors. This step is simple but can save time and hassle.
• Confirm eligibility before working with a client.  If you want help, hire a billing service.

Using 96110 Correctly

• Use 96110 for developmental screenings and tests, especially in pediatric care. It’s crucial to use it for these specific assessments only.
• This includes evaluations of developmental milestones in areas like speech, motor skills, and social behavior.

Documentation Done Right

• Record every aspect of the screening – what tests were used, how long they took, and the outcomes.
• Show how the screening connects to the child’s overall care plan.

Staying in Line with Insurance

• Different insurers have varied rules for developmental screenings. Always check the patient’s policy for specifics on coverage.
• Incorrect coding is a common error. Double-check that CPT 96110 is the right code for the services provided.(Source)

Who Can Bill 96110

• Qualified Practitioners: CPT Code 96110 is typically billed by pediatricians, family physicians, and other healthcare providers trained in child development.
• Specialized Providers: This can also include psychologists, nurse practitioners, and physician assistants with expertise in developmental screenings.

Need streamlined billing and expert assistance?

Reach out to our billing service – we’re here to help you navigate these processes with ease.