Coding for Pediatric Behavioral and Developmental Screenings
Simplify pediatric screening billing with accurate coding for behavioral and developmental tests. Ensure smooth claims processing and correct reimbursements for your practice.

Pediatric Billing & Coding Alert
Coding for Pediatric Behavioral and Developmental Screenings involves using standardized tools to assess a child’s developmental milestones and behavioral health. These screenings help pediatricians identify potential delays or concerns early, enabling timely interventions. Proper coding ensures that these services are accurately reported for reimbursement and record-keeping. This guide offers essential insights into the correct application of codes for behavioral and developmental screenings, helping pediatricians navigate the complexities of billing and ensuring compliance with industry standards.
How to Report Developmental Screening/Testing in 2025
In 2025, the process of reporting developmental screenings and testing for pediatric patients continues to rely on the accurate use of Current Procedural Terminology (CPT®) codes. These codes ensure that pediatricians report developmental services correctly for billing, reimbursement, and documentation purposes. Below is a detailed guide on how to report developmental screening and testing services.
Developmental Screening (CPT Code 96110)
CPT code 96110 is used when a standardized developmental screening tool is applied to assess a child’s developmental milestones. Tools such as the Ages and Stages Questionnaire (ASQ), M-CHAT, and Pediatric Evaluation of Developmental Status (PEDS) are common examples. These screenings involve an observer’s evaluation of the child’s skills, usually completed by a caregiver or other informal observer.
It is important to note that screenings assess skills subjectively through observation and do not diagnose a condition.
When to Report
- Preventive Services: When developmental screening is part of a routine well-child visit or preventive checkup.
- Evaluation and Management (E/M) Services: Code 96110 can also be reported when screening is performed in conjunction with other services, such as an office visit for an acute illness, follow-up care, or chronic condition management.
Modifiers and Multiple Screens
- Modifier 25: If an E/M service is provided along with the developmental screening, use modifier 25 to indicate that the E/M service was a distinct and necessary part of the visit. This shows that both services were provided on the same day.
- Multiple Screens: If multiple screenings are conducted during a single visit (e.g., using both M-CHAT and ASQ), report 96110 for each standardized instrument used, and use modifier 59 to indicate that the services were distinct.
Time and Billing Considerations
Code 96110 is often performed by clinical staff and typically reflects practice expenses rather than physician work. It does not count toward the key components (history, physical exam, medical decision-making) for selecting an E/M code. However, if a physician performs the screening, the work involved in the screening itself should not count toward E/M time or components.
Developmental Testing (CPT Code 96111)
CPT code 96111 is used for developmental testing services that involve standardized instruments to evaluate a child’s motor, language, cognitive, social, and adaptive skills. Examples of testing tools include the Bayley Scales of Infant Development, Woodcock-Johnson Tests of Cognitive Abilities, and Clinical Evaluation of Language Fundamentals (CELF). Unlike screening, testing is more objective, as it measures the child’s actual abilities at the time of assessment.
When to Report
- Standalone Testing: When developmental testing is provided independently, without any additional E/M service.
- With E/M Services: If developmental testing is performed alongside an office visit for a distinct service (e.g., an E/M consultation or check-up), modifier 25 should be used to indicate that the testing is separate and necessary. If the testing service is distinct, modifier 59 should be added to the developmental testing code.
Physician Involvement
Developmental testing typically requires a trained professional, often a pediatrician or psychologist, to administer the assessment. For this reason, 96111 has associated physician work relative value units (RVUs) in the Medicare Resource-Based Relative Value Scale (RBRVS), which reflect both the time and expertise required to perform the test.
Time and Reporting
While earlier revisions to 96111 required reporting by time, the current guidelines no longer include a “per hour” designation. Testing is reported without regard to the duration, and the time spent on interpretation and reporting should not be factored into E/M codes when both services are provided on the same day.
Key Considerations for 2025
In 2025, the terminology continues to emphasize the difference between screening (subjective observation) and testing (objective measurement). The guidelines for both 96110 and 96111 stress the importance of using validated, standardized instruments for these assessments, with code descriptors clearly differentiating the types of services.
Multiple Units for Multiple Screens
As of 2025, if multiple standardized screening tools are administered during the same encounter, each tool should be reported separately using 96110 with the appropriate number of units. For example, if both M-CHAT and ASQ are performed, report 96110 twice with the use of modifier 59 if necessary to distinguish between the two services.
Documentation and Scoring
The most recent revisions to 96110 have replaced "interpretation and report" with "scoring and documentation." This reflects the nature of developmental screening, where clinical staff must accurately document the screening instrument's results. The updated descriptor ensures that the focus remains on recording observations through validated instruments.
When to Report Developmental Screening/Testing
Developmental screening and testing are essential components of pediatric care. The frequency of reporting these services depends on the clinical situation and the physician’s judgment regarding the patient’s needs. Below is a breakdown of when to report developmental screening and testing, including relevant CPT codes.
Developmental Screening (CPT Code 96110)
Developmental screening should be reported when a standardized or validated screening tool is used to assess a child’s development. The American Academy of Pediatrics (AAP) recommends developmental surveillance at each preventive visit, and standardized screening tools should be used to detect early signs of developmental delays. The frequency of reporting CPT code 96110 is determined based on clinical judgment.
Key Points:
- Developmental screening involves the use of tools like the Ages and Stages Questionnaire (ASQ) or PEDS (Parent Evaluation of Developmental Status).
- It is part of routine well-child visits but must be distinguished from informal developmental surveys or history-taking.
- Not reportable if the physician is only asking general developmental questions during the visit or using informal checklists.
- Reportable when a standardized instrument is used to evaluate a child’s development and developmental concerns are raised.
Developmental Testing (CPT Code 96111)
Developmental testing is more comprehensive and typically done when screening suggests an abnormality or developmental delay. It involves more formal assessments and often requires the involvement of a skilled clinician (e.g., psychologist, pediatrician, or other trained professional). These tests are generally time-intensive and may require one or more sessions to complete.
Key Points:
- CPT Code 96111 is reported for more comprehensive developmental testing.
- It is typically performed when screening or surveillance results indicate a possible delay.
- These tests include structured observations and standardized tests, which may take more than an hour.
- The physician or psychologist must provide a formal report of the results.
- Reportable when a child requires further evaluation due to abnormal screening results or concerns raised during the clinical assessment.
CPT Code 96110: Developmental Screening (Example Scenarios)
Scenario |
Description |
Code(s) |
Vignette 1 |
A pediatrician asks a parent to complete the Ages and Stages Questionnaire (ASQ) during a follow-up visit. The questionnaire shows no concerns regarding developmental milestones. |
96110, Z00.121 |
Vignette 2 |
During a 24-month check-up, a mother expresses concerns about her child’s language skills. The pediatrician uses the PEDS screening tool, and the results indicate a delay in language. |
96110, Z00.121, F80.1 |
Vignette 3 |
A pediatrician administers developmental screening to a 5-year-old at their health maintenance visit after a parent reports concerns about social interaction. |
96110, Z00.129, F82 |
CPT Code 96111: Developmental Testing (Example Scenarios)
Scenario |
Description |
Code(s) |
Vignette 1 |
An 8-year-old boy undergoes a series of standardized tests to evaluate his attention span and working memory after initial screening suggested attention deficit disorder (ADD). |
96111, F90.0 |
Vignette 2 |
A 5-year-old child presents with significant language delays. The pediatrician conducts developmental testing, including the Peabody Picture Vocabulary Test, which confirms a mixed receptive-expressive language disorder. |
96111, F80.2 |
Important Notes on Reporting
- Modifier 59: Some payers may request that a modifier 59 be appended to CPT 96110, but according to CPT guidelines, this is not required. There is no need for a modifier unless the testing was provided in a different context or setting (e.g., separate sessions).
- Frequency of Reporting: Both CPT 96110 and CPT 96111 should be reported based on clinical need, but 96111 is typically used for more in-depth testing when initial screening suggests a developmental issue.
- Documentation: For both screening and testing, proper documentation is required to support the use of the CPT code. This includes a detailed summary of the screening tool used, results, and any follow-up actions (referrals, additional testing).
Developmental Test Administration Clinical Example
A 9-year-old patient presents for a new patient visit due to a progressive pattern of academic and social struggles since preschool. The school has raised concerns about autism and has requested an evaluation. Along with gathering a detailed history (including past medical, family, and social history) and performing a comprehensive review of systems (ROS), the clinician administers the KBIT2, WIAT, and ADOS2 as part of the evaluation. The results indicate that the patient meets the criteria for autism diagnosis, and counselling is provided during the visit.
The total visit time is 45 minutes, with 25 minutes dedicated to counselling and care coordination. This involves discussing the diagnosis and providing guidance to the patient and family. An additional 90 minutes are spent administering the developmental tests, followed by 60 minutes for scoring, interpreting, and creating the report, which is also shared with the school.
CPT Code Reporting and Modifiers
Based on the documentation provided, the following CPT codes and modifiers should be reported:
- 99204-25: Evaluation and Management (E/M) service. This code reflects 45 minutes of E/M time, where counselling and care coordination dominate the service.
- Modifier 25 is added to indicate that this E/M service is significant and separately identifiable, distinct from the developmental testing.
- 96112: This code is used for the first 76 minutes of total time spent on developmental testing and interpretation.
- 96113: Three units are reported for the remaining 74 minutes of developmental testing and interpretation.
ICD-10-CM Codes
- F84.0: Autistic disorder (primary diagnosis).
- Additional codes may be used to identify related conditions or co-morbidities, as required:
- F94.9: Childhood disorder of social functioning, unspecified.
- F81.0: Specific reading disorder.
- F81.2: Mathematics disorder.
- F80.1: Expressive language disorder.
Summary of Reported Codes
- CPT Codes:
- 99204-25: E/M service for counseling and coordination of care.
- 96112: Developmental test administration (including assessment of fine and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified health care professional, with interpretation and report; first hour
- 96113: Developmental test administration (including assessment of fine and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified health care professional, with interpretation and report; each additional 30 minutes (List separately in addition to code for primary procedure)
- ICD-10-CM Code(s):
- F84.0: Autistic disorder (primary diagnosis).
- Additional codes for any related conditions, if applicable.
Why BillingFreedom is the Best for Pediatric Behavioral and Developmental Screenings
BillingFreedom excels in managing pediatric behavioral and developmental screening codes with precision. Our expertise in handling CPT codes like 96110, 96111, 96112, and 96113 ensures accurate billing for developmental testing and screenings. Whether it's for autism assessments, developmental delays, or behavioral concerns, we ensure that all procedures, such as PEDS, ASQ, or ADOS2, are properly documented and coded.
We also handle complex ICD-10-CM coding and CPT codes for pediatric behavioral and development screenings, including F84.0 for autism and additional codes for co-morbidities. By streamlining the billing process, we reduce denials and improve reimbursement rates, making BillingFreedom the trusted partner for pediatric practices.
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