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The CPT® Code 96112 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 assessments focus on an individual's ability to receive, send, process, and comprehend information through verbal, non-verbal, and graphic means. Cognitive evaluations measure thinking, reasoning, problem-solving abilities, and may also assess memory, intelligence, attention, and executive functioning within different contexts. The physical domain encompasses a comprehensive evaluation of health status, including hearing and vision, as well as an assessment of gross and fine motor skills, muscle tone, and overall physical development. Social-emotional development is examined through the ability to form attachments, express emotions, and respond to the emotional states of others. Lastly, the adaptive domain evaluates the acquisition of skills necessary for daily living, such as sleeping, eating, toileting, and mobility. Standardized assessment tools utilized in this process may focus on specific areas or cover multiple domains, with common tests including the Peabody Picture Vocabulary Test (PPVT), Clinical Evaluation of Language Fundamentals (CELF), and the Woodcock-Johnson Test of Cognitive Abilities, among others. The code 96112 specifically reports the first hour of developmental test administration conducted by a physician or other qualified healthcare professional, which includes the interpretation of results and the generation of a report detailing the findings.
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The administration of developmental tests under CPT® Code 96112 is indicated for the evaluation and monitoring of developmental skills in individuals from infancy to adolescence. The following conditions and symptoms may warrant the use of this procedure:
The procedure for administering developmental tests as described by CPT® Code 96112 involves several key steps that ensure a comprehensive evaluation of the individual's developmental status. The following procedural steps are typically followed:
Post-procedure care following the administration of developmental tests under CPT® Code 96112 typically involves providing the individual and their caregivers with the results of the assessment. The healthcare professional may discuss the findings in detail, highlighting areas of strength and any identified developmental delays or concerns. Additionally, recommendations for further evaluation, intervention strategies, or referrals to specialists may be provided based on the results. It is important for the individual and their caregivers to understand the implications of the findings and the next steps in the developmental support process. Follow-up appointments may be scheduled to monitor progress and adjust interventions as needed.
| Short Descr | DEVEL TST PHYS/QHP 1ST HR | Medium Descr | DEVELOPMENTAL TST ADMIN PHYS/QHP 1ST HOUR | 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; first hour | Status Code | Active Code | Global Days | XXX - Global Concept Does Not Apply | 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 | Codes That May Be Paid Through a Composite APC | Type of Service (TOS) | 5 - Diagnostic Laboratory | Berenson-Eggers TOS (BETOS) | none | MUE | 1 |
This is a primary code that can be used with these additional add-on codes.
| 96113 | Telehealth Service (Medicare) Add-on Code MPFS Status: Active Code APC N 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) |
| 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. | GW | Service not related to the hospice patient's terminal condition | 25 | Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service: it may be necessary to indicate that on the day a procedure or service identified by a cpt code was performed, the patient's condition required a significant, separately identifiable e/m service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed. a significant, separately identifiable e/m service is defined or substantiated by documentation that satisfies the relevant criteria for the respective e/m service to be reported (see evaluation and management services guidelines for instructions on determining level of e/m service). the e/m service may be prompted by the symptom or condition for which the procedure and/or service was provided. as such, different diagnoses are not required for reporting of the e/m services on the same date. this circumstance may be reported by adding modifier 25 to the appropriate level of e/m service. note: this modifier is not used to report an e/m service that resulted in a decision to perform surgery. see modifier 57 for significant, separately identifiable non-e/m services, see modifier 59. | 32 | Mandated services: services related to mandated consultation and/or related services (eg, third party payer, governmental, legislative or regulatory requirement) may be identified by adding modifier 32 to the basic procedure. | 93 | Synchronous telemedicine service rendered via telephone or other real-time interactive audio-only 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 away 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 is sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction. | 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. | AH | Clinical psychologist | GN | Services delivered under an outpatient speech language pathology plan of care | GT | Via interactive audio and video telecommunication systems | GX | Notice of liability issued, voluntary under payer policy | KX | Requirements specified in the medical policy have been met | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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