How To Use CPT Code 96112

CPT 96112 refers to the administration of developmental tests by a physician or qualified healthcare professional, including interpretation and report. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 96112.

1. What is CPT 96112?

CPT 96112 is a medical billing code used to describe the administration of standardized developmental tests by a physician or other qualified healthcare professional. These tests assess various aspects of a patient’s development, such as fine and gross motor skills, language, cognitive level, social skills, memory, and executive functions. The code also includes the interpretation of test results and the preparation of a report.

2. 96112 CPT code description

The official description of CPT code 96112 is: “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.”

3. Procedure

The 96112 CPT code procedure involves the following steps:

1. The provider explains the tests to the patient, parent, and/or guardian and answers any questions they ask.
2. The provider administers the tests in writing or orally.
3. Multiple tests are administered to determine the exact nature and extent of the patient’s developmental delay, if any.
4. Fine motor skills, gross motor skills, language level, cognitive abilities, executive functions, and social skills are assessed using standardized tests.
5. The provider takes an hour or more to interpret the tests.
6. The provider reviews and interprets the test results and discusses the next steps with the patient or the patient’s parent or guardian.

4. Qualifying circumstances

Patients eligible to receive CPT code 96112 services are those who may have developmental delays or disorders and require a comprehensive assessment of their developmental skills. This may include children with suspected developmental delays, autism spectrum disorder, intellectual disabilities, or other conditions that may impact their overall development. The provider must be a physician or other qualified healthcare professional trained in administering and interpreting standardized developmental tests.

5. When to use CPT code 96112

It is appropriate to bill the 96112 CPT code when a physician or qualified healthcare professional administers standardized developmental tests to assess a patient’s developmental skills and prepares a report with the interpretation of the test results. This code should be used for the first hour of test administration. For each additional 30 minutes of testing, CPT code 96113 should be used.

6. Documentation requirements

To support a claim for CPT 96112, the following information must be documented:

• The specific standardized tests or tools used during the assessment.
• Test scores and interpretation, indicating whether the results are normal or abnormal.
• A discussion of the test results with the patient, parent, or guardian.
• A copy of the actual questionnaire or test in the patient’s record for future reference.

7. Billing guidelines

When billing for CPT code 96112, keep in mind the following guidelines:

• Use this code only once per date of service.
• Ensure that supporting documentation includes test interpretation, score, and discussion.
• Do not count the time and effort to perform the developmental test toward the key components of an E/M service when billed in conjunction with CPT 96112.
• Modifier 59 may be appended to 96112 to differentiate the developmental testing services at the same visit from the E/M services.

8. Historical information

CPT 96112 was added to the Current Procedural Terminology system on January 1, 2019. There have been no updates since its addition.

9. Similar codes to CPT 96112

Five similar codes to CPT 96112 and how they differentiate are:

• CPT 96113: Used for each additional 30 minutes of developmental testing.
• CPT 96110: Used for developmental screening, rather than comprehensive testing.
• CPT 96127: Used for brief emotional/behavioral assessment.
• CPT 96130: Used for psychological test administration and scoring by a physician or other qualified healthcare professional.
• CPT 96131: Used for each additional hour of psychological test administration and scoring.

10. Examples

Here are 10 detailed examples of CPT code 96112 procedures:

1. A 4-year-old child with suspected autism spectrum disorder undergoes a comprehensive developmental assessment, including tests for language, cognitive, and social skills.
2. A 6-year-old child with a history of speech delays is assessed for language and cognitive development using standardized tests.
3. An 8-year-old child with suspected attention deficit hyperactivity disorder (ADHD) undergoes testing for executive functions and memory.
4. A 3-year-old child with a history of motor delays is assessed for fine and gross motor skills using standardized tests.
5. A 5-year-old child with suspected intellectual disability undergoes a comprehensive developmental assessment, including tests for cognitive and adaptive skills.
6. A 7-year-old child with a history of social difficulties is assessed for social skills and language development using standardized tests.
7. An 11-year-old child with a history of learning difficulties undergoes testing for cognitive and executive functions.
8. A 9-year-old child with suspected developmental coordination disorder is assessed for fine and gross motor skills using standardized tests.
9. A 2-year-old child with a history of global developmental delays undergoes a comprehensive developmental assessment, including tests for motor, language, cognitive, and social skills.
10. A 10-year-old child with a history of emotional and behavioral difficulties is assessed for cognitive, social, and executive functions using standardized tests.