Reimbursement, Coding and Billing

CPT (Current Procedural Terminology) code 96110 is to be used to document, and be reimbursed for, the use of “developmental screening tools of a limited nature,” such as the ASQ or PEDS. For more information, see the AAP’s Coding Fact Sheet For Primary Care Physicians.

Excerpt from AAP Section on Developmental and Behavioral Pediatrics Newsletter, Fall 2007:
The relative value units (RVUs) associated with the CPT code for screening (96110) do not cover physician time. The code was written for a service administered (explained to the parent and the screening copy scored) by a non-physician. The physician then interprets the ‘score’ and discusses the results with the parent, but this ‘work’ is already assumed to be included in either the preventive service or evaluation and management (E/M) codes. This means that screening should be administered and scored by office staff, with interpretation of findings conducted by the primary care clinician. The lack of RVUs for physician time make it essential to train staff as to why early detection is essential and working with them to determine the optimal flow of extra papers through the office (eg, whether screens should be distributed to families in waiting rooms or exam rooms; who will score the screen, attach results to the chart, identify resources, create referral letters, etc?).

Click here to open the Provider Services page for the Colorado Medical Assistance Program where you will find the current Medicaid fee schedule and the instructions on how to read it.

Click here to go the Child Health Plan Plus (CHP+) website to find the reimbursement for the State plan.

With regard to private insurance companies, we have heard reports of reimbursements between $0 and $40, and as developmental screening becomes more common, an increasing number of insurance companies are covering the service.