Developmental screening can be billed as a service added to your office visit charge (well child or other office evaluation and management visit).
Billing code 96110 covers a physician or a non-physician administering a standardized screening instrument to a child’s guardian or other observer, and reflects only the physician time reviewing the scores and interpreting the findings with the family (rather than the actual work of giving the survey). Using this code requires documentation that the screen was given and the actions taken.
When adding the 96110 screening code to an evaluation and management visit, American Medical Association CPT (Current Procedural Terminology) codes guide providers to append the modifier “-25” to the E/M code. Given that the evaluation is a significant, separate service from the screening procedure, it’s acceptable to bill 96110 for every screening tool used. However, individual payers may contract with participating providers to include the screen within preventive care or E/M, or may direct their providers to bill differently from the AMA’s CPT guidelines. As of 2009, Medicaid has allocated $12.98 for each unit of 96110.
In Massachusetts, reimbursement remains variable. Debate continues as to whether validated screening is already covered in our Early and Periodic Screening, Diagnostic, and Treatment Service (EPSDT) allotment. Fortunately, our local AAP chapter is actively involved in advocating for more consistent reimbursement.
Much of this information comes from Lynn M. Wegner, M.D., chair of the AAP section of Developmental Behavioral Pediatrics. Updates may be found on the sdbp.org or dbpeds.org websites.