With the addition of Current Procedural Terminology (CPT) code 96127 for emotional and behavioral assessment, questions have arisen regarding the appropriate code for some of the instruments administered to pediatric patients.

The confusion lies in whether to classify an instrument as a developmental assessment (CPT code 96110) or as an emotional and behavioral assessment (CPT code 96127). Since there may be overlap with some instruments, it is important to identify the appropriate code.

While the two codes represent two distinct assessments, both codes have many similarities. For example, neither requires that a physician or other qualified health care professional perform the assessment. Because clinical staff typically administer the assessment, neither code contains any physician work value. In addition, both codes require that the instruments are standardized, and both codes may be reported “per instrument.”

It is acceptable to report both codes in addition to preventive medicine service codes (e.g., 99392,...

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