CPT Code 96113: Developmental Testing, Each Additional 30 Minutes

Developmental test administration involves structured, standardized testing tools used by a qualified health care professional to assess a child's cognitive, motor, language, or social-emotional functioning. In contrast, developmental behavioral screening typically refers to brief, preliminary evaluations to detect potential developmental concerns before full testing is conducted. Both are valuable but serve different roles in the evaluation process.

Yes, patients may be eligible for reimbursement when CPT code 96113 is billed correctly, accompanied by supporting documentation and a demonstration of medical necessity. Each additional 30-minute unit of developmental test administration must be clearly documented and follow the initial hour billed under CPT 96112. Insurance coverage can vary, so providers should consult payer-specific policies for confirmation.

Providers can find official guidance from the American Medical Association (AMA), the Centers for Medicare & Medicaid Services (CMS), and payer-specific provider manuals. These sources outline the appropriate documentation, time thresholds, and billing rules to ensure compliant use of developmental test administration codes, such as 96113, and related services, including developmental behavioral screening.