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CPT Code 96113: Developmental Testing, Each Additional 30 Minutes

CPT code 96113 covers each extra 30 minutes of developmental test administration. Learn billing, documentation, screening, and reimbursement guidelines.

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Table of content

What is developmental testing (each additional 30 minutes)?CPT code 96113 documentation requirements CPT code 96113 billing guidelines Other relevant CPT codes

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What is developmental testing (each additional 30 minutes)?

CPT code 96113 is used to report each additional 30 minutes of developmental testing performed by a physician or other qualified health care professional. This service must follow the primary procedure, CPT code 96112, which covers the first hour of direct test administration and evaluation.

The 96113 CPT code is essential in documenting extended developmental and behavioral screening sessions that require more than 60 minutes of face-to-face time. It supports thorough screening and testing of various developmental domains in infants, toddlers, and children, such as:

Cognitive function
Language and communication
Motor skills (fine and gross)
Social and emotional development
Adaptive behaviors

These assessments may help diagnose or evaluate conditions like autism spectrum disorder, developmental delays, ADHD, and intellectual disability. Developmental screening and testing often involve tools like the Bayley Scales, Vineland Adaptive Behavior Scales, or the Battelle Developmental Inventory.

CPT code 96113 documentation requirements

To properly report 96113, clear documentation is required to justify the service provided and support billing for each additional 30-minute interval. Providers must include:

Total testing time beyond the initial hour (e.g., “additional 60 minutes of testing”)
Specific developmental domains evaluated
Standardized developmental test instruments used
Child’s behavioral screening and testing responses
Clinical interpretation and impressions
A detailed report of the assessment results

The documentation must reflect medical necessity and distinguish this extended test administration from routine developmental screening or informal observation.

CPT code 96113 billing guidelines

When billing CPT code 96113, providers must adhere to these billing guidelines:

Must be billed with CPT 96112; 96113 is an add-on code and cannot be billed alone
Each unit of 96113 equals 30 minutes of additional developmental testing
For 90 minutes of testing, bill 96112 + 96113 (1 unit)
For 2 hours, bill 96112 + 96113 (2 units)
Testing can span multiple days if time thresholds are met
Only qualified health care professionals (e.g., psychologists, pediatricians, or physician assistants) may report this code

It's important to check with private insurers, Medicaid, or the Medicare program for payer-specific billing requirements, including diagnosis codes, time tracking, and pre-authorization rules.

Other relevant CPT codes

Several related CPT codes are frequently used in developmental and behavioral screening and test administration:

96112 – Developmental testing, first hour (primary procedure)
96110 – Brief developmental screening with standardized tool
96116 – Neurobehavioral status exam

Each of these codes represents unique services within pediatric behavioral health and diagnostic evaluations.

Frequently asked questions

What is the difference between developmental test administration and developmental behavioral screening?

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.

Are patients eligible for reimbursement under CPT code 96113?

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.

Where can providers find guidance on billing CPT code 96113?

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.