2025 CPT code 96127
(Active) Effective Date: N/A Revision Date: N/A Cognitive Services - Central Nervous System Assessments/Tests Medicine Services and Procedures Feed
Developmental/behavioral testing, per instrument, with interpretation and report.
Modifiers may apply depending on the circumstances of service. Consult the latest CPT manual for guidance on appropriate modifier usage.
Medical necessity is established by the presence of clinical concerns, developmental delays, behavioral problems, or suspected diagnosis requiring developmental or behavioral assessment.The chosen instruments should be age and developmentally appropriate.
A qualified healthcare professional (physician, psychologist, or other qualified provider) administers and interprets the standardized instrument and generates a report documenting findings.
In simple words: This code covers tests that check a person's development and behavior.A trained professional gives the test, looks at the results, and writes a report.
This CPT code encompasses developmental and behavioral testing services.The procedure includes administration of a standardized instrument, scoring, interpretation of results, and generation of a report by a qualified healthcare professional. The unit of service is per instrument used.
Example 1: A pediatrician uses the Bayley Scales of Infant and Toddler Development to assess the developmental progress of a 2-year-old child exhibiting delayed language skills. The test results inform the pediatrician’s diagnosis and treatment plan, and a comprehensive report is generated for the patient's file., A school psychologist administers the Conner's Rating Scale to evaluate a student suspected of having ADHD. The test's findings help determine the student's eligibility for special education services and inform interventions and accommodations., A clinical psychologist uses the Autism Diagnostic Observation Schedule (ADOS) to assess a child suspected of having Autism Spectrum Disorder.The detailed report generated from the ADOS assists in confirming diagnosis and guiding individualized intervention strategies.
* Patient demographics and identifying information.* Detailed description of the reason for referral and assessment.* Specific instrument used and its version.* Documentation of the test administration and scoring procedures.* Interpretation of results with specific findings.* Comprehensive report summarizing findings and recommendations.* Copies of the standardized test materials may be required.
** The interpretation and report component is integral to this code.Incomplete or missing documentation will result in claim denials.
- Revenue Code: T2D - OTHER TESTS - OTHER
- Payment Status: Active
- Modifier TC rule: Not applicable
- Specialties:Pediatrics, Psychology, Neuropsychology, Psychiatry, Education
- Place of Service:Office, Hospital, School, Other outpatient settings