Advocacy Success: Providers Can Continue to Use CPT Code 96110 to Bill for Developmental Screenings

Posted on: February 3, 2012

In late 2011, the U.S. Centers for Medicare and Medicaid Services (CMS) issued a Final Rule to stop covering services associated with CPT code 96110, a code used to bill for developmental, behavioral and psychosocial screening. Since Medicaid and private pay systems often depend on Medicare payment rules, concern existed that CMS’ decision could impact children enrolled in Medicaid and in private health insurance plans.

Along with the AAP and numerous other organizations committed to the health of children, ICAAP took action, submitting comments to CMS to advocate for the reinstatement of 96110, and encouraging interested ICAAP members and partners to submit their own comments. ICAAP thanks all those who participated in advocating for this reinstatement. To learn more about the course of events and ICAAP activity to protect pediatric provider’s ability to be reimbursed for providing critical developmental screening services, click here.

Efforts by these stakeholder groups have led to CMS reversing its recent decision to not publish RVUs for CPT code 96110. CMS responded to the concerns of AAP leadership, chapters, and members who filed comments objecting to the removal of published values for payment for this important procedure. Read the CMS informational bulletin to learn more about this decision reversal.

Pediatric providers in Illinois should continue to use CPT code 96110 to bill Medicaid and private payers for developmental screening services. Illinois Health Connect also offers bonus payments for objective developmental screenings given prior to ages 12, 24, and 36 months. To learn more about developmental screening and referral, register for a free, online training course on the Enhancing Developmental Oriented Primary Care Project (EDOPC) website.

Thank you to those who participated in this effort. Once again, your advocacy made a difference!