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CPT code 96113 is an add-on code used alongside 96112 when extended developmental testing exceeds the initial hour. It applies to each additional 30 minutes spent administering standardized tests, interpreting data, and preparing reports. This allows providers to accurately report the full scope of services when evaluating developmental, behavioral, or cognitive concerns in children or adolescents.
This service is typically used by psychologists, developmental pediatricians, or other qualified healthcare professionals who perform comprehensive assessments using tools such as the Bayley Scales, ADOS-2, or Vineland.
CPT Code 96113 Description
96113 – Each additional 30 minutes of developmental test administration, scoring, interpretation, and report preparation by a qualified healthcare professional, used in conjunction with 96112.
This is a time-based add-on code and cannot be billed independently. It supports billing for prolonged services when an extended assessment is clinically justified.
Clinical Scenarios When CPT 96113 is Applicable
1. Multi-Domain Developmental Assessment
A child referred for evaluation of cognitive delay requires testing across several domains (language, motor, adaptive behavior, and emotional regulation). The provider conducts an extended assessment lasting 90 minutes. CPT 96112 is billed for the first hour, and CPT 96113 is billed for the additional 30 minutes.
2. Autism Spectrum Disorder Evaluation with Parent Interview
A developmental psychologist spends over 1.5 hours conducting structured observation, testing, and reviewing parent-reported data. Due to the complexity of the case, two hours are required, including interpretation and reporting. CPT 96112 is paired with two units of 96113.
3. Comprehensive School-Age Learning Assessment
For a child showing signs of a learning disorder, multiple standardized tests are administered to assess memory, executive functioning, and attention. The process takes 2.5 hours, including scoring and analysis. CPT 96112 + 96113, repeated three times, accurately reflects the service time.
4. Reassessment After Treatment
Following six months of speech therapy, a re-evaluation is conducted with updated testing and comparison to prior results. Due to increased testing scope, an additional 60 minutes are required beyond the initial hour.
5. Complex Case Requiring Detailed Report Writing
In cases involving legal documentation, school accommodations, or multiple providers, additional time is needed to prepare a comprehensive report that supports recommendations and referrals.
Documentation Requirements (H3 Headings with Paragraph Explanation)
Time Allocation Must Be Tracked
Each unit of 96113 requires a minimum of 16 minutes. Document the specific start and end times for test administration, interpretation, and report writing beyond the first hour.
Breakdown of Additional Services
List the extended testing components and additional domains evaluated during the extra time, such as executive function, visual-motor skills, or emotional regulation.
Test Instruments and Tools Used
Indicate all testing tools utilized during the extended period, such as NEPSY, WISC-V subtests, or specific motor coordination assessments.
Rationale for Extended Testing
Justify why testing required additional time, such as patient complexity, attention span, or expanded clinical questions.
Report Details
Highlight what additional information was included in the report, such as differential diagnosis, long-term planning, or multidisciplinary referrals.
Reimbursement Tips for CPT Code 96113
- Only bill 96113 with 96112, and ensure proper sequencing on claims.
- Track cumulative time accurately and avoid rounding up. Each additional 30-minute unit must meet the time threshold.
- Use appropriate modifiers such as 95 for telehealth or 25 when billing with evaluation services.
- Document thoroughly to avoid denials for insufficient justification of extra time.
- Check payer-specific caps on testing hours per visit or per year.
Typical Reimbursement Rates
- Medicare: $50–$65 per unit
- Private Insurance: $60–$80 per unit
- These rates depend on geographic region and payer policies.
Why MindCare is the Right Choice for Developmental Testing Billing
MindCare understands the challenges of billing time-based developmental services, where accuracy in both time and documentation can significantly impact revenue. Our team ensures that every unit of 96113 is properly justified and billed to reflect the full value of your work.
We support clinicians with tailored billing solutions that capture additional time, prevent missed units, and handle payer-specific nuances. Whether you're billing one extra unit or four, our process eliminates undercoding and accelerates reimbursement.
MindCare’s Developmental Billing Advantage
- Verified documentation for each 96113 unit
- Real-time time-tracking tools to ensure compliance
- Denial prevention through proactive claim audits
- Detailed reporting support for high-stakes cases
- Ongoing payer guideline monitoring for 2025 updates
Explore our full range of Mental Health Billing Services to streamline your developmental and psychological assessments.
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.
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