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TABLE 2

CPT Codes for Developmental Screening

Services/Step in AlgorithmNotesCPT CodeComments
Pediatric preventive care visit All preventive care visits should include developmental surveillance; screening is performed as needed or at periodic intervals 99381–99394 (EPSDTa 
Developmental screening The expectation is that the screening tool will be completed by a parent or nonphysician staff member and reviewed by the physician 96110 Limited developmental testing, with interpretation and report 
Developmental/medical evaluation If performed by the physician as an outpatient office visit 99210–99215b or 96110; or 96111 if objective developmental testing is performed 99214 is used for evaluations performed by the physician that are detailed and moderately complex or take at least 25 min (with over half spent counseling); 99215 is used for evaluations that are comprehensive and highly complex or take >40 min (with over half spent counseling) 99244 is used for “moderate activities” of up to 60 min; 99245 is used for “high” activity of up to 80 min 
 Outpatient consultation; typically performed by a tertiary, local out-of-office referral source or another physician with the requisite skills in the same practice as the referring physician; the request for consultation must be recorded in the patient's chart; services/procedures and consulting physician's impressions must be recorded; time spent counseling and coordinating care should bespecifically documented; these codes include “reporting” of the consulting physician, if completed by letter or office notes 99241–99245  
 If a more extensive report is developed, this code is used; these costs may not be reimbursable 99080  
Developmental disorder identified For follow-up visits with the patient and parents to complete the consultation or to discuss the results of the initial consultation; for rendering opinions and addressing questions, not assuming care; once care is assumed, established office-visit coding is used 99241–99245  
Identify as a child with special health care needs, and initiate chronic-condition management Children with special health care needs are likely to require expanded time and a higher level of medical decision-making found in these “higher-level” outpatient codes; these codes are appropriate for services in the office and for outpatient facility services for established patients; these codes may be reported using time alone as the factor if more than half of the reported time is spent in counseling 99211–99215 99213; 99214; 99215 (see above) 
Prolonged services At any point during the algorithm when outpatient office or consultation codes are used, prolonged physician service codes may be reported in addition when visits require considerably more time than typical for the base code alone; both face-to-face and non–face-to-face codes are available in CPT 99354 99354 for first 30–74 min of outpatient face-to-face prolonged services 
  99355 99355 for each additional 30 min 
  99358 99358 for first 30–74 min of non–face-to-face prolonged services 
  99359 99359 for each additional 30 min 
Extended developmental testing/evaluation Used for extended developmental testing typically provided by the medical provider (often up to 1 h) including the evaluation interpretation and report 96111 Reported in addition to evaluation and management (E/M) services provided on the same date 
Services/Step in AlgorithmNotesCPT CodeComments
Pediatric preventive care visit All preventive care visits should include developmental surveillance; screening is performed as needed or at periodic intervals 99381–99394 (EPSDTa 
Developmental screening The expectation is that the screening tool will be completed by a parent or nonphysician staff member and reviewed by the physician 96110 Limited developmental testing, with interpretation and report 
Developmental/medical evaluation If performed by the physician as an outpatient office visit 99210–99215b or 96110; or 96111 if objective developmental testing is performed 99214 is used for evaluations performed by the physician that are detailed and moderately complex or take at least 25 min (with over half spent counseling); 99215 is used for evaluations that are comprehensive and highly complex or take >40 min (with over half spent counseling) 99244 is used for “moderate activities” of up to 60 min; 99245 is used for “high” activity of up to 80 min 
 Outpatient consultation; typically performed by a tertiary, local out-of-office referral source or another physician with the requisite skills in the same practice as the referring physician; the request for consultation must be recorded in the patient's chart; services/procedures and consulting physician's impressions must be recorded; time spent counseling and coordinating care should bespecifically documented; these codes include “reporting” of the consulting physician, if completed by letter or office notes 99241–99245  
 If a more extensive report is developed, this code is used; these costs may not be reimbursable 99080  
Developmental disorder identified For follow-up visits with the patient and parents to complete the consultation or to discuss the results of the initial consultation; for rendering opinions and addressing questions, not assuming care; once care is assumed, established office-visit coding is used 99241–99245  
Identify as a child with special health care needs, and initiate chronic-condition management Children with special health care needs are likely to require expanded time and a higher level of medical decision-making found in these “higher-level” outpatient codes; these codes are appropriate for services in the office and for outpatient facility services for established patients; these codes may be reported using time alone as the factor if more than half of the reported time is spent in counseling 99211–99215 99213; 99214; 99215 (see above) 
Prolonged services At any point during the algorithm when outpatient office or consultation codes are used, prolonged physician service codes may be reported in addition when visits require considerably more time than typical for the base code alone; both face-to-face and non–face-to-face codes are available in CPT 99354 99354 for first 30–74 min of outpatient face-to-face prolonged services 
  99355 99355 for each additional 30 min 
  99358 99358 for first 30–74 min of non–face-to-face prolonged services 
  99359 99359 for each additional 30 min 
Extended developmental testing/evaluation Used for extended developmental testing typically provided by the medical provider (often up to 1 h) including the evaluation interpretation and report 96111 Reported in addition to evaluation and management (E/M) services provided on the same date 
a

EPSDT (Early and Periodic Screening, Diagnosis, and Treatment) is the federal Medicaid program for preventive services. States may require physicians to use different codes to report these services. In general, for non-Medicaid commercial insurers, the evaluation and management CPT codes for preventive medicine services (99381-99394) are used for the basic service (history, physical examination, and counseling/anticipatory guidance), with separate CPT codes reported additionally for the additional screening of hearing, vision, development, laboratory services, and immunization administration.

b

CPT evaluation and management code levels are selected on the basis of the amount of physician work (history, physical examination, and medical decision-making) and/or time used in the encounter.

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