5/21/2024

Structured Screening for Developmental Delays and Autism Spectrum Disorders (ASDs)

Developmental surveillance and screening for developmental delays and ASDs should be conducted at intervals established by the recognized medical organizations involved in child health care, primarily the American Academy of Pediatrics (AAP). According to the AAP, structured screening for developmental delays and ASDs is the use of standardized, scientifically validated tools to identify and refine a recognized risk.

Providers should conduct structured screenings to focus on the identification of additional risk factors by targeting specific developmental milestones in language and cognitive abilities, fine and gross motor skills, and social interactions as well as signs and symptoms of ASDs. Providers should also conduct structured screening outside of the recommended screening periods if medically necessary.

Network providers can reference the chart below when conducting structured screening for Highmark Wholecare members.

Age Developmental Screening Autism Spectrum Disorder Screening
9 months 96110 N/A
18 months 96110 96110 U1
24 months N/A 96110 U1
30 months 96110 N/A

When the validated screening tool identifies that the child needs further assessment, a diagnostic evaluation should be performed by the provider or through a referral to an appropriate specialist or the early intervention program. Providers can refer for Early Intervention services or for services through the local area Intermediate Unit by contacting the CONNECT Helpline at 1-800-692-7288.

Billing

All Early Periodic Screening, Diagnostic, and Treatment (EPSDT) screening services must be reported with the age-appropriate evaluation and management code along with the EP modifier.

EPSDT Screening CPT Codes:

  • Ages 1 month - 11 months EPSDT visit CPT Code is 99381 or 99391.
  • Ages 12 months - 4 years EPSDT visit CPT Code is 99382 or 99392.
  • The CPT code for Developmental Screening is 96110.
  • The CPT code for Autism Screening is 96110 U1.

For questions regarding the EPSDT program, please contact EPSDTinfo@HighmarkWholecare.com and refer to our provider website.

These codes are not all encompassing and use does not guarantee payment. They are intended as a guide to provide education around appropriate screenings and coding as part of the EPSDT program.

 

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