TABLE 5

CPT Codes for Developmental Screening

Services/Step in AlgorithmNotesCPT CodeComments
Pediatric preventive care visitAll preventive care visits should include developmental surveillance; screening is performed as needed or at periodic intervals99381–99394 (EPSDT)
Developmental/medical evaluation: Office or Other Outpatient Services Codes; New PatientIf performed by the physician as a new patient outpatient office visit99201-9920599204 is used for evaluations performed by the physician that are detailed and moderately complex or take at least 45 min (with more than half spent counseling); 99205 is used for evaluations that are comprehensive and highly complex or take 60 min (with more than half spent counseling)
Developmental/medical evaluation: Office or Other Outpatient Services Codes; Established PatientIf performed by the physician as an outpatient office visit99210–9921599214 is used for evaluations performed by the physician that are detailed and moderately complex or take at least 25 min (with more than half spent counseling); 99215 is used for evaluations that are comprehensive and highly complex or take 40 min (with more than half spent counseling)
Developmental/medical evaluation/Office or Other Outpatient Consultations CodesIf performed by the physician as an outpatient office visit99241–9924599244 is used for “moderate activities” of up to 60 min (with more than half spent counseling); 99245 is used for “high” activity of up to 80 min (with more than half spent counseling)
Developmental screeningDoes not require any physician work; rather, clinical staff can score results and provide to physician for interpretation as part of E/M96110Reported in addition to E/M services provided on the same date
Developmental testingUsed for extended developmental testing typically provided by the medical provider (often up to 1 h), including the evaluation interpretation and report96111Reported in addition to E/M services provided on the same date
Identify as a child with special health care needs, and initiate chronic condition managementChildren with special health care needs are likely to require expanded time and a higher level of medical decision-making found in these “higher-level” outpatient codes; these codes are appropriate for services in the office and for outpatient facility services for established patients; these codes may be reported using time alone as the factor if more than half of the reported time is spent in counseling99211–99215As above
Prolonged servicesAt any point during the algorithm when outpatient office or consultation codes are used, prolonged physician service codes may be reported in addition when visits require considerably more time than typical for the base code alone; both face-to-face and non–face-to-face codes are available in CPT9935499354 for first 30–74 min of outpatient face-to-face prolonged services
9935599355 for each additional 30 min
9935899358 for first 30–74 min of non–face-to-face prolonged services
9935999359 for each additional 30 min
  • E/M, evaluation and management; EPSDT, Early and Periodic Screening, Diagnostic and Treatment program.