Superior Developmental Screening and Testing (CPT 96110, 96112 and 96113)

Date: 06/04/20

Superior has recently completed a comprehensive review of its requirements for the provision and payment for developmental screening and testing benefits for Medicaid (STAR, STAR Health, STAR Kids) children. As a result of that assessment, we identified several opportunities to align Superior’s administration of these Medicaid covered benefits more closely with the benefit guidelines and limitations specified in the Texas Medicaid Provider Procedures Manual (TMPPM). 

Effective for dates of service July 1, 2020 and after, Superior’s administration of these services will mirror the scope, frequency, duration and age restrictions for each applicable service code, as specified in the TMPPM, Chapters 5.3.11.1.2 Developmental Surveillance or Screening and 9.2.24 Developmental Screening and Testing and Aphasia Assessment. 

Please refer to the TMPPM for detailed specifications, requirements and limitations for these services to ensure compliance with requirements beginning July 1, 2020, including the following summary highlights:

• No prior authorization will be required for Medicaid developmental screening and testing services.
• Developmental screening (CPT 96110) will be restricted to patients through the age of 6 years and allowed once per rolling year outside of Texas Health Steps.
• Developmental testing (CPTs 96112 and 96113) will be restricted to patients through the age of 20 years and allowed twice per rolling year through the same provider.
• Advanced practice registered nurses, physician assistants, and psychologists are limited to a maximum, combined total of 12 hours per day for developmental screening and testing, and inpatient and outpatient mental health services.

Developmental screening and testing are covered services for Superior CHIP members.

Developmental (CPT 96110) and autism screening (CPT 96110, modifier U6) services are eligible for reimbursement when provided during a preventive care exam for children through age 6, consistent with the American Academy of Pediatrics (AAP) periodicity schedule for pediatric preventive care.

Standardized developmental screening outside of a preventive care exam as part of development and neurological assessment testing, once per rolling year for CHIP members through the age of 6 years, and developmental testing (CPTs 96112 and 96113) allowed twice per rolling year for CHIP members through the age of 19.

For any questions, please contact your local Account Manager.