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TO: EPSDT
Providers
RE: Objective
Developmental Testing
Effective for dates of service on
or after April 1, 2024, the Alabama Medicaid Agency (Medicaid) is updating its
policy regarding objective developmental testing. Objective developmental
testing is when a physician or other health care professional measures
cognitive, motor, social, language, adaptive, and/or cognitive abilities using
provider standardized tests (meeting industry standards) via written, oral, or
combined format testing. The following codes apply to testing for developmental
disorders for recipients up to 20 years old and
must include the interpretation and report on the findings.
A. Procedure Codes:
1. 96112 – 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 healthcare
professional, with interpretation and report; first hour
Ø Report 96112 for the
initial hour of testing, with interpretation and report.
Ø 96112 may not be
reported for less than 31 minutes of time.
2. 96113 – Each additional 30 minutes (list
separately in addition to code 96112)
Ø Report 96113 for each
additional 30 minutes, with interpretation and report.
Ø 96113 may not be
reported for less than 16 minutes.
B. Documentation Requirement:
1. Generally, the
documentation of objective developmental testing will include: scoring,
interpretation, and preparation of a separate identifiable report.
Ø The report must include
the following: identifying data, date/time and
location of testing, reason for the type of testing being done, and titles of
all instruments completed by the child.
Ø The report must also
include the test protocol, all scoring sheets, and the scored item results.
Ø The provider’s interpretation
and plan need to be noted in the report.
2. An appropriate provider
signature and date is required according to Alabama Administrative Code Rule
560-X-1-.18.
3. The total time spent on these services for
the patient is required. If time is not documented, the code(s) may not be
reported.
Ø If the testing is
performed over several days, the time for all testing should be combined and
reported on the last day of service.
C. These
services will be subject to post-payment review.
Providers with policy questions may contact
Medicaid’s Physician Program at Physicians.Program@medicaid.alabama.gov.
Providers with billing questions may
contact the Gainwell Technologies Provider Assistance Center at 1-800-688-7989.
The Current Procedural Terminology (CPT) and Current Dental Terminology
(CDT) codes descriptors, and other data are copyright © 2024
American Medical Association
and © 2024 American Dental Association (or such other date publication of CPT and
CDT). All rights reserved. Applicable FARS/DFARS apply.