Fall 2016

During the course of a medical record review project for measures of developmental screening among children ages one through three years, Neighborhood learned that many providers may not be aware of the billing guidelines for these screenings.

Neighborhood’s clinical medical policy for Pediatric Development and Autism Screeningstates that up to 5 screenings without authorization are covered before age three (3), based on the following recommended schedule

• Developmental Screening should be performed at 9 months, 18 months and 30 months.
• Autism Screening should be performed at 18 months and 24 months.

The same CPT code (96110) is used to bill for both general developmental screening and for autism screening. Use the “U1” modifier when billing to differentiate the autism screening. You can bill separately, one instance with the modifier and one without, if both screens were performed during the same visit.

If these screenings are automated as part of your practice’s EMR, you will still need to bill CPT code 96110 to indicate that the screening was completed. Additionally, this code is not on the capitation listing. It is a covered service and will pay out as fee for service over and above the capitation payment.

For more information, please refer to the clinical medical policy located in the Providers section of Neighborhood’s website.