CPT® Code 96113

Official Description

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)

Common Language Description

The CPT® Code 96113 refers to the administration of developmental tests, which are essential tools used to evaluate and monitor the acquisition of expected skills in individuals from infancy through adolescence. These tests help confirm the presence and extent of disabilities across various developmental domains. The five primary domains assessed include communication, cognitive, physical, social/emotional, and adaptive skills. Communication tests focus on an individual's ability to receive, send, process, and comprehend information through verbal, non-verbal, and graphic means. Cognitive assessments evaluate critical thinking, reasoning, problem-solving abilities, and may also encompass memory, intelligence, attention, and executive functioning skills. The physical domain assessment includes a comprehensive evaluation of health status, sensory capabilities such as hearing and vision, and the development of gross and fine motor skills, muscle tone, and overall physical limitations. Social-emotional development is assessed through the ability to form attachments, express emotions, and respond appropriately to the emotional states of others. Lastly, the adaptive domain measures the acquisition of skills necessary for coping with daily physical and environmental demands, including activities such as sleeping, eating, toileting, and mobility. Standardized assessment tools utilized in this process may focus on a single domain or encompass multiple areas of development. Commonly used tests include the Peabody Picture Vocabulary Test (PPVT), Clinical Evaluation of Language Fundamentals (CELF), and the Woodcock-Johnson Test of Cognitive Abilities, among others. Code 96112 is used to report the first hour of developmental test administration, while code 96113 is designated for each additional 30 minutes of testing performed by a physician or other qualified healthcare professional, including the interpretation of results and the generation of a report.

1. Indications

The administration of developmental tests under CPT® Code 96113 is indicated for various reasons, primarily to evaluate and monitor the developmental progress of children from infancy to adolescence. The following conditions and symptoms may warrant the use of these tests:

Developmental Delays: To assess children who exhibit delays in acquiring expected developmental milestones across various domains.
Disabilities: To confirm the presence and extent of disabilities that may affect a child's ability to communicate, learn, or interact socially.
Monitoring Progress: To track the developmental progress of children who have previously been diagnosed with developmental disorders or delays.
Assessment of Skills: To evaluate specific skills in communication, cognitive abilities, physical development, social/emotional functioning, and adaptive behavior.
Referral for Services: To provide necessary documentation for referrals to early intervention services, special education programs, or therapeutic interventions.

2. Procedure

The procedure for administering developmental tests as described by CPT® Code 96113 involves several key steps, which are detailed below:

Step 1: Preparation for Testing The healthcare professional prepares for the administration of developmental tests by selecting appropriate standardized instruments based on the child's age, developmental level, and specific areas of concern. This preparation may include reviewing the child's medical history and previous assessments to tailor the testing process effectively.
Step 2: Administration of Tests The qualified healthcare professional administers the selected developmental tests, which may include a combination of assessments targeting communication, cognitive, physical, social/emotional, and adaptive domains. Each test is conducted in a structured environment to ensure consistency and reliability in the results.
Step 3: Interpretation of Results After the tests are completed, the healthcare professional interprets the results, analyzing the data collected to identify strengths and weaknesses in the child's development. This interpretation is crucial for understanding the child's overall developmental profile.
Step 4: Reporting The final step involves generating a comprehensive report that summarizes the findings of the developmental tests. This report includes detailed interpretations of the results, recommendations for further evaluation or intervention, and any necessary referrals to other healthcare providers or services.

3. Post-Procedure

Post-procedure care following the administration of developmental tests under CPT® Code 96113 typically involves providing the family with the results and recommendations based on the assessment. The healthcare professional may discuss the findings in detail, addressing any concerns the family may have regarding the child's development. Additionally, if further interventions or services are recommended, the healthcare provider will assist in coordinating these services, which may include referrals to specialists, early intervention programs, or educational resources. Follow-up appointments may also be scheduled to monitor the child's progress and reassess developmental milestones as needed.

Short Descr	DEVEL TST PHYS/QHP EA ADDL
Medium Descr	DEVELOPMENTAL TST ADMIN PHYS/QHP EA ADDL 30 MIN
Long Descr	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)
Status Code	Active Code
Global Days	ZZZ - Code Related to Another Service
PC/TC Indicator (26, TC)	0 - Physician Service Code
Multiple Procedures (51)	0 - No payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50)	0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions	04 - Physician supervision policy does not apply when procedure is furnished by a qualified, independent psychologist...
Assistant Surgeon (80, 82)	0 - Payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62)	0 - Co-surgeons not permitted for this procedure.
Team Surgery (66)	0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	Items and Services Packaged into APC Rates
Type of Service (TOS)	5 - Diagnostic Laboratory
Berenson-Eggers TOS (BETOS)	none
MUE	6

This is an add-on code that must be used in conjunction with one of these primary codes.

96112

Telehealth Service (Medicare) MPFS Status: Active Code APC Q3 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

AH	Clinical psychologist
59	Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
95	Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system: synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located at a distant site from the physician or other qualified health care professional. the totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that would be sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction. modifier 95 may only be appended to the services listed in appendix p. appendix p is the list of cpt codes for services that are typically performed face-to-face, but may be rendered via a real-time (synchronous) interactive audio and video telecommunications system.
FR	The supervising practitioner was present through two-way, audio/video communication technology
GX	Notice of liability issued, voluntary under payer policy