2025 CPT code 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 health care professional, with interpretation and report; first hour.
Modifiers may be applicable depending on the circumstances of service.Refer to the CPT manual for guidance.
Medical necessity for this code is established when there are concerns regarding a child's development and a comprehensive assessment is needed to identify potential delays or disorders that can benefit from early intervention.The necessity should be documented in the patient's chart.
The clinical responsibility includes administering standardized developmental tests to assess various aspects of the patient's development, interpreting the results, and generating a report summarizing findings and recommendations.This may involve explaining the tests to the patient's family and answering questions.
- Medicine Services and Procedures > Central Nervous System Assessments/Tests (eg, Neuro-Cognitive, Mental Status, Speech Testing)
- Central Nervous System Assessments/Tests
In simple words: The doctor or therapist gives your child a series of tests to check how their development is progressing. This includes checking their physical skills (like using their hands and walking), their language, how they think and solve problems, and how they interact with others. The results are then used to create a report.
This CPT code encompasses developmental test administration, including assessments of fine and gross motor skills, language abilities, cognitive levels, social skills, memory, and executive functions using standardized developmental instruments.The service includes interpretation of the results and preparation of a report by a physician or other qualified healthcare professional. This code is for the first hour of testing.
Example 1: A 3-year-old child is brought in for developmental assessment due to concerns about language delays. The physician administers the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) and the Clinical Evaluation of Language Fundamentals, Fourth Edition (CELF-4).The results are interpreted, and a report is generated indicating a language delay and recommendations for speech therapy., A 5-year-old child is referred for assessment due to behavioral issues in school. The psychologist administers the Wechsler Preschool and Primary Scale of Intelligence—Fourth Edition (WPPSI-IV) and the Behavior Assessment System for Children, Third Edition (BASC-3).The results are interpreted, and a report is generated suggesting ADHD and recommending behavioral therapy., A 7-year-old child is evaluated for possible learning difficulties. The educational psychologist administers the Woodcock-Johnson IV Tests of Achievement and the Test of Nonverbal Intelligence-4 (TONI-4). The results are interpreted and a report is generated suggesting dyslexia and recommending academic support.
* Detailed documentation of the tests administered.* Specific scores and results obtained for each test.* Clinical interpretation of the results, including any identified strengths and weaknesses.* A comprehensive report summarizing the findings and outlining recommendations.* Documentation of the time spent administering the tests and interpreting the results.
** This code should only be billed once per day for the first hour of testing.Additional time should be billed using code 96113.Appropriate documentation is crucial for proper reimbursement.Always refer to the current CPT manual for the most up-to-date guidelines.
- RVU: The relative value units (RVUs) for this code may vary depending on the payer and location.Consult your specific payer's fee schedule for the most current RVU values.
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Fee Schedule: Historical fee schedule data is not available in this source.
- Specialties:Pediatrics, Developmental Behavioral Pediatrics, Psychology, Educational Psychology, Occupational Therapy, Speech-Language Pathology
- Place of Service:Office, Hospital (Inpatient or Outpatient), Outpatient clinic, School, Other