Billing Guidelines for Developmental and Mental Health Screening and Assessment in Primary Care Table 1: Pediatric Screening/Assessments in Healthy Kids Preventive Health Schedule Recommendation from Examples of Acceptable Billing Guidelines Limitations Healthy Kids Preventive Standardized Tools Health Schedule Post-partum Screening recommended Patient Health 96161: Caregiver-focused 96161 will be reimbursed up to 4 units total depression at 1, 2, 4 and 6 month well Questionnaire-9 health risk assessment per child through age 12 months. 0 units will screening child checks. Providers be reimbursed age 13 months and older. may be billed only when a may with Edinburgh Postnatal standardized screening “pre-screen” PHQ-2 to determine if a Depression Scale (EPDS) tool is used. PHQ-2 may longer standardized not be billed. screening tool is needed. Billing should occur under child’s MA number Developmental Surveillance Ages and Stages 96110: Developmental 96110 will be reimbursed up to 8 units total screening recommended at well Questionnaires (ASQ) screening may be billed per child through age 5 years. 0 units will be child visit; use of Parents’ Evaluation of only when a standardized reimbursed age 6 years and older. standardized screening Developmental Status screening tool is used and tool required for all (PEDS) results documented A maximum of 2 of 96110 will be children at 9, 18 and 24 reimbursed per visit when both a general months (and whenever developmental screen and an autism screen concern). are conducted; OR 96110 may be combined with other screening codes when appropriate (ex. 96127) for a maximum of 2 units of screening reimbursed per visit Autism Surveillance Modified Autism 96110: Developmental 96110 will be reimbursed up to 8 units total screening recommended at every Checklist in Toddlers, screening may be billed per child through age 5 years. 0 units will be well child visit; use of Revised with Follow-up only when a standardized reimbursed age 6 years and older. standardized screening (MCHAT-R/F): 16-30 screening tool is used and tool required for all months results documented A maximum of 2 units of 96110 will be children at 18 and 24 reimbursed per visit; OR
Billing Guidelines for Developmental and Mental Health Screening and Assessment in Primary Care Table 1: Pediatric Screening/Assessments in Healthy Kids Preventive Health Schedule Recommendation from Healthy Kids Preventive Health Schedule Examples of Acceptable Standardized Tools Billing Guidelines Limitations Post-partum depression screening Screening recommended at 1, 2, 4 and 6 month well child checks. Providers may “pre-screen” with PHQ-2 to determine if a longer standardized screening tool is needed. Patient Health Questionnaire-9 Edinburgh Postnatal Depression Scale (EPDS) 96161: Caregiver-focused health risk assessment may be billed only when a standardized screening tool is used. PHQ-2 may not be billed. Billing should occur under child’s MA number 96161 will be reimbursed up to 4 units total per child through age 12 months. 0 units will be reimbursed age 13 months and older. Developmental screening Surveillance recommended at well child visit; use of standardized screening tool required for all children at 9, 18 and 24 months (and whenever concern). Ages and Stages Questionnaires (ASQ) Parents’ Evaluation of Developmental Status (PEDS) 96110: Developmental screening may be billed only when a standardized screening tool is used and results documented 96110 will be reimbursed up to 8 units total per child through age 5 years. 0 units will be reimbursed age 6 years and older. A maximum of 2 of 96110 will be reimbursed per visit when both a general developmental screen and an autism screen are conducted; OR 96110 may be combined with other screening codes when appropriate (ex. 96127) for a maximum of 2 units of screening reimbursed per visit Autism screening Surveillance recommended at every well child visit; use of standardized screening tool required for all children at 18 and 24 Modified Autism Checklist in Toddlers, Revised with Follow-up (MCHAT-R/F): 16-30 months 96110: Developmental screening may be billed only when a standardized screening tool is used and results documented 96110 will be reimbursed up to 8 units total per child through age 5 years. 0 units will be reimbursed age 6 years and older. A maximum of 2 units of 96110 will be reimbursed per visit; OR
Coding-Guidelines-for-Screening-Tools-Primary-Care-final.docx