Early identification and treatment of children at risk for developmental delay is critical to helping them achieve their full potential in life.
The foundation for all aspects of a child’s healthy development (physical, behavioral, cognitive, and social/emotional) is laid during the first three years of life. Fortunately, a child’s developmental trajectory is dynamic. Children learn from every interaction, so developmental interventions, when offered early, can support healthy development, help to prevent developmental delay, and prepare children for school and a lifetime of well-being.
Below there are two maps that highlight state Medicaid policies around developmental screening reimbursement and screening tools.
Click here to find a detailed chart of developmental screening policy information by state.
Medicaid Fee for Service Reimbursement for Developmental Screening
Reimburses CPT 96110 (46)
Does not reimburse CPT 96110 (5)
* Note: Washington, DC is not pictured on the map, but is included in the counts above. It reimburses 96110 at $10.30 within FFS, two units maximum, and is required during EPSDT visits.
Nearly all (46) states reimburse Current Procedural Terminology (CPT) code 96110 for developmental screening.
One state (NY) does not reimburse 96110, but requires developmental screening as part of EPSDT.
At least two states (Hawaii and Utah) that reimburse 96110 do not pay if the code is billed in conjunction with an EPSDT visit. North Carolina also had this policy until 2016.
Medicaid fee-for-service reimbursement rates for 96110 range from about $5 to $62.
Two states (CT and MA) use a modifier with 96110 to indicate whether a screening was positive or negative.
At least four states (ME, MN, PA, and TX) also use 96110 for autism screening and require the use of a modifier to distinguish the screening type.