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CPT code 96112 is used to report extended developmental testing services conducted by qualified healthcare professionals. It applies when a more comprehensive evaluation is required beyond brief screenings, involving face-to-face interaction, interpretation of test data, and preparation of a detailed report.
This service is typically used to assess developmental disorders, cognitive function, language processing, and other neurodevelopmental domains in children. It is often administered during the early childhood or school-age years when concerns arise about delays, learning disabilities, or behavioral issues.
CPT Code 96112 Description
96112 – Developmental test administration (including assessment of motor, language, social, adaptive, and/or cognitive functioning by standardized developmental instruments), per hour of the qualified healthcare professional’s time, with interpretation and report.
This code encompasses the direct administration of tests, scoring, interpretation, and preparation of a written report. It is reported that the first hour of service is covered. If additional time is required, 96113 is billed for each subsequent 30 minutes.
Clinical Scenarios: When to Use CPT 96112
Here are realistic and enhanced examples of when CPT 96112 is appropriately used:
1. In-depth Cognitive and Language Evaluation
A 4-year-old child is referred due to suspected developmental delays. A psychologist conducts a 1-hour testing session using standardized tools to assess cognitive, motor, and language domains. An interpretation and a written report are prepared to guide intervention planning.
2. Autism Spectrum Disorder Evaluation
A child displaying repetitive behavior and poor social interaction is assessed using tools such as the ADOS-2 and the Vineland Adaptive Behavior Scales. The session requires structured administration, interpretation, and clinical reporting.
3. School Readiness and IQ Testing
A child who has difficulty following instructions in class undergoes developmental testing to evaluate school readiness, executive function, and adaptive behavior.
4. Post-Treatment Functional Assessment
Following early intervention, a re-evaluation is conducted to determine current functioning and to update goals. This involves re-administering previous tools, comparing results, and creating a new report.
5. Diagnostic Clarification for Behavioral Challenges
In cases where behavioral symptoms overlap with ADHD or anxiety, developmental testing helps differentiate diagnoses through structured cognitive and emotional assessment tools.
Documentation Requirements (H3 Headings with Explanatory Paragraphs)
Standardized Instruments Used
Clearly identify all testing instruments used (e.g., Bayley Scales, WPPSI, Vineland). These must be developmentally appropriate and standardized for the population being assessed.
Time Spent on Testing and Reporting
Document the total time spent face-to-face with the patient, as well as the time used for interpretation and report writing. For CPT 96112, a minimum of 31 minutes is required to bill the code.
Clinical Purpose of the Testing
Explain why the developmental testing was necessary, such as to evaluate delays, assess treatment progress, or determine eligibility for services.
Interpretation and Summary of Results
Include a written interpretation of findings, including relevant scores, what they indicate about the child’s developmental level, and any diagnostic impressions.
Recommendations and Follow-up Plan
Provide a clear summary of recommendations, such as referrals to specialists, therapy, or educational planning.
Reimbursement Tips for CPT Code 96112
- Bill 96112 for the first hour only. Use 96113 for each additional 30-minute increment.
- Time Tracking is Essential: Keep accurate logs of time spent testing, interpreting, and documenting.
- Avoid Unbundling: Do not bill 96112 together with screening codes like 96110 for the same instruments.
- Place of Service Considerations: Ensure the appropriate setting is listed (clinic, school, home) as required by the payer.
- Modifier Use: May require modifiers such as 95 (telehealth) or 25 (distinct service) depending on payer rules.
Typical Reimbursement Rates
- Medicare: $110–$135 for the first hour
- Private Insurance: $120–$150
- Rates may vary by region and setting.
Why Choose MindCare for Developmental Testing Billing
At MindCare, we understand that extended developmental testing is a valuable and time-intensive service. That's why our billing solutions are designed to capture every billable detail from standardized test documentation to accurate time tracking and modifier application.
We specialize in pediatric and psychological billing, ensuring that providers receive full reimbursement for complex services, such as 96112. With payer-specific knowledge, denial-prevention strategies, and automated documentation checks, we help you deliver high-quality care without revenue loss.
Our Developmental Billing Expertise Includes:
- Proper CPT pairing with 96113 and related codes
- Document validation tools to prevent undercoding
- Modifier management for multi-service visits
- EMR integration support for test logging and report uploads
- Appeals support for time-based code denials
Explore our comprehensive Mental Health Billing Services to discover how we assist providers in streamlining complex developmental and psychological evaluations.
Let Mind Care Billing Help
We help mental health providers use the correct CPT codes, avoid denials, and get paid faster. If you're unsure which code to use, or tired of dealing with rejections, our team can take billing off your plate entirely.
Schedule a Free Consultation with Mind Care Billing today — and leave the coding confusion behind.
