How To Use HCPCS Code G9966

HCPCS code G9966 describes the screening of children for risk of developmental, behavioral, and social delays using a standardized tool with interpretation and report. This code is used to identify and bill for the specific service provided by healthcare providers. In this article, we will explore the details of HCPCS code G9966, including its official description, procedure, when to use it, billing guidelines, historical information, Medicare and insurance coverage, and provide examples of when this code should be billed.

1. What is HCPCS G9966?

HCPCS code G9966 is a specific code used to identify the screening of children for risk of developmental, behavioral, and social delays using a standardized tool with interpretation and report. It allows healthcare providers to accurately document and bill for this particular service.

2. Official Description

The official description of HCPCS code G9966 is as follows: “Children who were screened for risk of developmental, behavioral, and social delays using a standardized tool with interpretation and report.” The short description for this code is “Scrn, inter, report child.”

3. Procedure

1. The healthcare provider begins by administering a standardized screening tool to the child.
2. They carefully interpret the results of the screening tool to identify any potential developmental, behavioral, or social delays.
3. Based on the findings, the provider prepares a detailed report summarizing the screening results and any recommended interventions or further evaluations.
4. The report is then shared with the child’s parents or guardians, as well as any relevant healthcare professionals involved in the child’s care.

4. When to use HCPCS code G9966

HCPCS code G9966 should be used when healthcare providers perform a screening for risk of developmental, behavioral, and social delays in children using a standardized tool. This code is applicable when the provider administers the screening, interprets the results, and prepares a report summarizing the findings and recommendations.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9966, healthcare providers need to ensure they document the following:

• The administration of the standardized screening tool
• The interpretation of the screening results
• The preparation of a detailed report summarizing the findings and recommendations

Providers should also include any relevant patient information, such as demographics and medical history, to support the necessity of the screening.

6. Historical Information and Code Maintenance

HCPCS code G9966 was added to the Healthcare Common Procedure Coding System on January 01, 2018. It has an effective date of January 01, 2021. As of December 31, 2020, this code has been terminated and is no longer in use. The termination of this code indicates that it is no longer valid for billing purposes.

7. Medicare and Insurance Coverage

Medicare and insurance coverage for HCPCS code G9966 may vary. It is important for healthcare providers to check with the specific payer to determine if this code is payable. The pricing indicator code for this code is 00, which means the service is not separately priced by Part B. The multiple pricing indicator code is 9, indicating that the value for this code is not established. Providers should consult the payer’s guidelines and fee schedules to understand how this service is priced and reimbursed.

8. Examples

Here are five examples of scenarios where HCPCS code G9966 should be billed:

1. A pediatrician administers a standardized screening tool to a 3-year-old child to assess their risk of developmental delays. The pediatrician interprets the results and prepares a report with recommendations for early intervention services.
2. A child psychologist conducts a behavioral screening using a standardized tool for a 6-year-old child with suspected attention deficit hyperactivity disorder (ADHD). The psychologist interprets the results and provides a detailed report to the child’s parents and school for further interventions.
3. A social worker performs a social-emotional screening on a 5-year-old child who has recently experienced a significant life event. The social worker analyzes the results and prepares a report outlining any potential social and emotional challenges and recommendations for support.
4. A speech-language pathologist administers a language development screening to a 4-year-old child who is experiencing speech delays. The pathologist interprets the results and prepares a report with recommendations for speech therapy services.
5. An early intervention specialist conducts a comprehensive developmental screening on an infant to assess their overall development. The specialist interprets the results and prepares a report with recommendations for early intervention services tailored to the child’s specific needs.