How to Bill CPT 96110 for Developmental Screening in Pediatrics

Your pediatrician completes a well-child visit, reviews an autism screening questionnaire, and discusses the results with the parents. The claim goes out with CPT 99392 and 96110. A few weeks later, the screening charge comes back unpaid.

The screening was performed. So what went wrong?

Sometimes it's a missing score. Other times, the payer allows only one screening per visit or expects a different claim format.

CPT 96110 reports developmental screening using a standardized instrument, with scoring and documentation. It can be billed alongside a well-child visit when the service meets coding and payer requirements.

Here's how to handle the claim, from choosing the right code to documenting the screening and correcting denials.

What Is CPT 96110 in Pediatric Billing

CPT 96110 is used to report developmental screening with a standardized instrument, including scoring and documentation, per instrument.

During well-child visits, pediatric providers may use tools such as ASQ-3, PEDS, or M-CHAT-R/F to check for possible developmental delays or concerns.

Simply asking a parent about a child’s speech or movement is part of routine developmental surveillance. CPT 96110 may be reported when a qualifying standardized screening tool is completed, and the service is documented.

The American Academy of Pediatrics recommends general developmental screening at 9, 18, and 30 months, and autism-specific screening at 18 and 24 months. Additional screening may be needed if concerns arise.

Accurate pediatric billing depends on documenting the screening performed and checking the applicable payer requirements.

How to Bill CPT 96110 With a Well-Child Visit

A developmental screening and a preventive examination may happen during the same appointment.

For example, a two-year-old attends a routine checkup. The pediatrician completes the preventive examination, while the clinical team administers and scores a standardized developmental questionnaire.

Both services may be separately reported when supported by documentation and payer policy.

CPT 96110 and Modifier 25: When Is It Required

Modifier 25 identifies a significant, separately identifiable evaluation and management service

performed on the same day as another procedure or service.

Some insurers require modifier 25 on the preventive medicine or E/M code when CPT 96110 is also reported. Others do not.

Do not automatically add modifier 25 to every well-child visit. Check the payer's billing instructions and whether the modifier is appropriate for the services documented.

When required, modifier 25 belongs on the appropriate E/M or preventive medicine code, not on CPT 96110.

Example: CPT 96110 Claim With CPT 99392

Claim line	CPT code	Service
1	99392	Established   patient preventive visit, ages 1–4
2	96110	Standardized   developmental screening

If the payer requires modifier 25 on the preventive service, the first line may be reported as 99392-25.

A different situation arises when the pediatrician also evaluates a separate medical problem during the

well-child visit. A significant, separately identifiable problem-oriented E/M service may support an additional office visit code with modifier 25.

That requires its own documentation. Simply mentioning a minor concern does not justify another E/M

charge.

Practices using pediatric billing services should have these same-day claim rules checked against each payer rather than applying one modifier setup to every visit.

How to bill multiple developmental screenings on the same visit

AAP Bright Futures guidelines call for both a general developmental screening and an autism-specific screening at certain ages. At the 18-month and 24-month well-child visits, you might give both the ASQ-3 and the M-CHAT-R/F during the same appointment.

You can bill for each validated tool. The billing method depends on the payer:

●      Multiple units: Some payers accept 96110 with 2 units on a single claim line. One unit for each tool you administered, scored, and documented.

●        Modifier 59: Other payers require two separate claim lines. Put 96110 on line 2 and 96110-59 on line 3. This tells the payer the second screening used a distinct instrument.

Check your payer's policy before you bill. Medicaid and commercial plans handle this differently, and some plans cap units at one per visit regardless of how many tools you use. Verify unit limits during eligibility checks, not after the claim bounces.

Documentation checklist for CPT 96110 reimbursement

Before submitting a CPT 96110 claim, check that the medical record shows which screening was performed and what the results were. Missing details can lead to claim denials or questions during an audit.

For CPT 96110 reimbursement, make sure the chart includes:

• Name of the validated screening tool: Record the tool used, such as ASQ-3, M-CHAT-R/F, or PEDS. General observation alone does not meet the standardized screening requirement.

• Screening score or result: Include the numerical score, risk category, or screening outcome. A note that only says “patient screened” does not show what the screening found.

• Interpretation and plan: Document the provider’s review of the results and any follow-up discussed with the family. If the results are normal, note the plan for routine monitoring. If concerns are identified, record the recommended next steps, such as a referral or further assessment.

Complete documentation helps support medical necessity and reduces the risk of reimbursement problems. Check the payer’s requirements, as documentation and reporting rules may vary.

CPT 96110 reimbursement rates by payer

Reimbursement for CPT 96110 varies by payer, plan type, and geography. Here are the ranges you can expect:

Payer Type	Typical Range per Unit	Notes
BCBS	$14.31 average	Varies by state and plan
UnitedHealthcare	$14.86 average	Check contract-specific rate
Aetna	$13.91 average	Network-dependent
Cigna	$17.99 average	Higher than average commercial rate
Medicaid	$15 - $35	State-dependent; EPSDT covers through age 21
CHIP	State-determined	Generally follows Medicaid guidelines

Some states cap Medicaid coverage at age 5 or 6 for developmental screening. California's Medi-Cal limits general screening through age 6. Texas restricts it outside Texas Health Steps visits. EPSDT rules technically allow screening through age 21 for Medicaid-eligible children when you can document medical necessity, but you'll need clear clinical justification.

At $15 to $18 per unit, CPT 96110 isn't a high-dollar code on its own. But at 30 to 40 screenings per month, it adds up to $5,400 to $8,640 per year per provider. That revenue disappears when claims get denied for avoidable documentation or modifier errors. Working with a pediatric medical billing services team that knows these payer-specific rules can stop the denials before they happen and recover the ones that slip through.

FAQ

1. What are the billing guidelines for the 96110 CPT code? 

CPT 96110 requires a completed, standardized developmental screening with scoring and documentation. Record the tool used and findings, and check payer rules for units, frequency, and reporting with other services.

2. What is the CPT code for developmental screening in children?

CPT 96110 is used for standardized developmental screening in children, including tools such as ASQ-3 and M-CHAT-R/F. The service must include scoring and documentation per instrument.

 3. What is the difference between 96110 and 96112? 

CPT 96110 covers brief, standardized developmental screening per instrument. CPT 96112 covers the first hour of qualifying developmental test administration and requires more extensive assessment and documentation.

Get Help With Pediatric Billing Services

Missing screening charges, incorrect modifiers, and repeated denials can leave completed pediatric services unpaid.

3 Axis RCM helps pediatric practices review developmental screening claims, address payer rejections, and manage outstanding reimbursements.

Explore our pediatric billing services to discuss your practice's billing needs.