2025 CPT code 96113
(Active) Effective Date: N/A Revision Date: N/A Diagnostic - Developmental/Behavioral Screening and Testing Central Nervous System Assessments/Tests Feed
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; each additional 30 minutes.
Modifier 59 may be appended to 96113 if it's performed on the same day as another procedure, and it's distinct and separate from the other service.Consult the CPT manual for specific modifier usage.
Medical necessity for 96113 is established when there are concerns about a child's developmental progress, including delays in speech, motor skills, cognitive development, or social interaction.The tests help diagnose developmental disorders, monitor progress, and guide treatment planning.
The clinical responsibility includes administering standardized developmental tests, interpreting the results, generating a report, and discussing the findings with the patient's parents or guardians.The provider must be qualified to perform these tasks (e.g., pediatrician, psychologist).
- Central Nervous System Assessments/Tests
- Central Nervous System Assessments/Tests > Developmental/Behavioral Screening and Testing
In simple words: This code covers extra time spent giving developmental tests to children.A doctor or other qualified healthcare professional gives the tests and explains the results to the child's parents or guardians.This code is only used if the testing takes longer than an hour.
This CPT code, 96113, represents the administration of developmental tests to assess various aspects of a child's development.The assessment may include fine and gross motor skills, language abilities, cognitive level, social skills, memory, and executive function. Standardized developmental instruments are used, and the service includes interpretation and report generation by a qualified professional. This code is an add-on code and should be reported in addition to the primary procedure code (96112) for each additional 30 minutes of testing beyond the initial hour.
Example 1: A 4-year-old child is referred for developmental testing due to concerns about speech delay.The initial assessment (96112) takes 1 hour, and additional testing (96113 x 2 units) is required to fully assess language, fine motor skills, and cognitive abilities. , A 2-year-old child is being screened for autism. The initial assessment takes 45 minutes (96112), and additional testing (96113 x 1 unit) is necessary to assess social skills, behavioral patterns, and interactions., A 3-year-old child with suspected ADHD undergoes a comprehensive developmental evaluation. The testing, which includes assessments of attention, executive function, and gross motor skills, extends over 2 hours (96112 + 96113 x 3 units).
* Detailed history of the child's development.* Results of all administered tests, including raw scores and interpretations.* Specific standardized tests used.* A comprehensive report summarizing the findings and recommendations for intervention.* Documentation of the discussion of findings with parents or guardians.
** This code is frequently used in conjunction with other assessment codes, depending on the specific needs of the patient.Always ensure complete and accurate documentation supports the medical necessity and the number of units billed.
- Payment Status: Active
- Modifier TC rule: A technical component modifier is not applicable to this code.
- Specialties:Pediatrics, Developmental-Behavioral Pediatrics, Psychology, Neurology
- Place of Service:Office, Outpatient Hospital, Pediatric Clinic