How To Use CPT Code 96113

CPT 96113 describes the administration of developmental tests by a physician or other qualified healthcare professional to assess various aspects of a child’s development. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 96113?

CPT 96113 can be used to report the administration of developmental tests by a physician or other qualified healthcare professional. These tests assess fine and/or gross motor skills, language abilities, cognitive level, social skills, memory, and executive functions using standardized developmental instruments. This code is used to indicate the administration, interpretation, and reporting of these tests for each additional 30 minutes beyond the primary procedure.

2. Official Description

The official description of CPT code 96113 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; each additional 30 minutes (List separately in addition to code for primary procedure)’

3. Procedure

1. The healthcare professional explains the developmental tests to the patient, parent, or guardian and addresses any questions or concerns.
2. Using standardized developmental instruments, the healthcare professional administers tests to assess fine and/or gross motor skills, language abilities, cognitive level, social skills, memory, and executive functions.
3. The healthcare professional may use written or oral tests to evaluate the patient’s developmental progress and identify any delays or abnormalities.
4. After administering the tests, the healthcare professional interprets the results and prepares a report detailing the findings.
5. The report includes an analysis of the patient’s performance on each test, an assessment of their developmental abilities, and recommendations for further evaluation or intervention if necessary.
6. If additional time beyond the primary procedure is required to administer and interpret the tests, CPT code 96113 is used to indicate each additional 30 minutes of service.

4. Qualifying circumstances

CPT 96113 is used for patients who require developmental testing to assess their fine and/or gross motor skills, language abilities, cognitive level, social skills, memory, and executive functions. These tests are typically performed on children to screen for possible developmental problems, confirm suspected problems, or monitor children at risk for developmental delays. The tests must be administered by a physician or other qualified healthcare professional using standardized developmental instruments.

5. When to use CPT code 96113

CPT code 96113 should be used when a physician or other qualified healthcare professional administers developmental tests using standardized instruments and requires additional time beyond the primary procedure to complete the testing and interpretation. This code should be reported for each additional 30 minutes of service provided beyond the initial procedure.

6. Documentation requirements

To support a claim for CPT code 96113, the healthcare professional must document the following information:

• The specific developmental tests administered
• The patient’s performance on each test
• An interpretation of the test results
• Any recommendations for further evaluation or intervention
• The start and end time of the additional 30-minute service
• The signature of the physician or qualified healthcare professional providing the service

7. Billing guidelines

When billing for CPT code 96113, ensure that the developmental tests are administered by a physician or other qualified healthcare professional using standardized instruments. Report this code for each additional 30 minutes of service beyond the primary procedure. It is important to note that the time and effort spent on developmental testing should not be counted towards the key components of an evaluation and management (E/M) service. Modifier 59 may be appended to differentiate the developmental testing services from the E/M services.

8. Historical information

CPT code 96113 was added to the Current Procedural Terminology system on January 1, 2019. There have been no updates to the code since its addition.

9. Examples

1. A physician administering developmental tests to assess a child’s fine and gross motor skills, language abilities, and cognitive level, spending an additional 30 minutes beyond the primary procedure.
2. A qualified healthcare professional administering standardized developmental instruments to evaluate a child’s social skills, memory, and executive functions, requiring an additional 30 minutes of service.
3. A physician interpreting the results of developmental tests and preparing a report on a child’s fine and gross motor skills, language abilities, and cognitive level, spending an additional 30 minutes beyond the primary procedure.
4. A qualified healthcare professional administering developmental tests to assess a child’s social skills, memory, and executive functions, and interpreting the results, requiring an additional 30 minutes of service.
5. A physician administering developmental tests to evaluate a child’s fine and gross motor skills, language abilities, cognitive level, social skills, memory, and executive functions, spending an additional 30 minutes beyond the primary procedure.
6. A qualified healthcare professional administering standardized developmental instruments to assess a child’s language abilities, cognitive level, social skills, memory, and executive functions, and interpreting the results, requiring an additional 30 minutes of service.
7. A physician administering developmental tests to assess a child’s fine and gross motor skills, language abilities, and cognitive level, and interpreting the results, spending an additional 30 minutes beyond the primary procedure.
8. A qualified healthcare professional administering standardized developmental instruments to evaluate a child’s social skills, memory, and executive functions, and preparing a report on the results, requiring an additional 30 minutes of service.