In this guide, we will teach you how to bill Add-On CPT Code 96113 for developmental and behavioral screening and testing, reimbursement rates for 96113, how long sessions last, and billing guidelines.
CPT Code 96113 Description
96113 Definition: Developmental and behavioral screening and testing administration, each additional 30 minutes
Time Frame for CPT Code 96113: 30 Minutes
CPT Code 96113 is used for each additional half-hour of developmental testing beyond the first hour utilized with CPT Code 96112.
In scenarios where a child may exhibit subtle or complex developmental issues, testing can extend to multiple hours, necessitating a thorough and nuanced approach.
This extended time frame billed under multiple units of CPT Code 96113 ensures that healthcare providers can dedicate the required attention without the constraints of shorter sessions.
Each additional billed unit of 96113 represents an additional half-hour of developmental screening, scoring, and testing.
If you wanted to bill three total hours of developmental testing and scoring administration, you would bill:
- CPT Code 96112 – 1 Unit – First Hour
- CPT Code 96113 – 4 Units – Second and Third Hours
2024 Reimbursement Rate for CPT Code 96113: $58.94
Reimbursement rates have had a gradual adjustment over the years:
- (2022): $66.54
- (2023): $59.98
- (2024): $58.94
These shifting rates reflect the evolving healthcare economy and have tangible implications for both providers and patients.
From a patient perspective, these rates influence the accessibility and affordability of extended developmental testing, a crucial component in managing complex developmental conditions. (Source)
Unfortunately for providers, rates for these services are being pushed down. Consider structuring services in a way that both maximize outcomes for clients and reward you appropriately for your time and energy.
If handling the billing side of this work sounds like a nightmare, consider hiring us at TheraThink to help.
How to Bill CPT Code 96113: Key Steps
- A review of client demographic and insurance information before submission can prevent delays and denials, so ensure you verify eligibility and benefits before working with the client.
- Record every additional half-hour of developmental testing with utmost precision.
- Use 96113 specifically for each half-hour beyond the initial hour of testing where 96112 was used.
- Double-check that all details in the claim align with the services provided or hire a service to help.
- Submit claims and track them.
CPT Code 96113 Guidelines
A frequent error is not accurately tracking and documenting the additional time spent on testing. Remember, this code is specifically for each extra 30 minutes, so precise timekeeping is crucial.
By providing a means to bill for extended testing, providers are able to ensure that clients receive comprehensive evaluations without rushing, leading to more accurate diagnoses and effective treatment plans. But again, it’s critical to keep careful, organized documentation about services provided. (Source)
License Level Requirements for CPT Code 96113
Who Can Bill?
CPT Code 96113 is typically billed by healthcare professionals who are qualified to conduct in-depth developmental assessments. This includes pediatricians, psychologists, and other specialists in child development.
Professionals must hold appropriate state licensure in their field of practice. This ensures they have the necessary training and expertise to conduct extended developmental testing.
State and Federal Considerations
Be aware that specific state regulations may dictate additional qualifications or conditions for billing extended developmental testing. On a federal level, compliance with healthcare laws and regulations, especially those related to pediatric and developmental health services, is crucial.
Remember, meeting these licensing requirements is not just about compliance; it’s about ensuring the highest standard of care for patients undergoing developmental assessments. As such, if you do not know if you are able to bill these services, it’s 99.9% likely you are not able to!
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For seamless handling of complex cases like these complex codes, reach out to our team of billing experts. We’re here to ensure your billing is accurate, efficient, and stress-free.