Developmental Screening

Developmental Screening

Updated March 30, 2021

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 are two maps that highlight state Medicaid policies around developmental screening reimbursement and screening tools.

Developmental screening serves a number of important purposes. Its primary purpose is to help identify children who are at risk of developmental delay so that that their needs can be assessed and addressed early in their lives.  The developmental screening process itself also creates an opportunity to talk to parents about developmental milestones, so they know what to look for as their children grow. Conducted consistently, screening provides a benchmark for tracking children’s development over time. Intervention and support services provided in early childhood can support children’s development and help them to be ready for school.

Most state Children’s Health Insurance Program (CHIP) and Medicaid programs support developmental screening by offering reimbursement to providers who use a validated, standardized screening tool. Several state early care and education Quality Rating Improvement Systems include developmental screening as well.  Developmental screening is also a Title V National Performance Measure (NPM 6).

Many tools are available to assess children’s development in the early years. Some of the most commonly recommended or used include:

General Development

Click here to find a detailed chart of developmental screening policy information by state. 

Medicaid Fee for Service Reimbursement for Developmental Screening

Policy Trends

  • Nearly all (47) states reimburse Current Procedural Terminology (CPT) code 96110 for developmental screening.
  • One state (New York) does not reimburse 96110, but recommends developmental screening as part of EPSDT well child visits.
  • Medicaid fee-for-service (FFS) reimbursement rates for 96110 range from $5 to $80.
  • One state (Connecticut) uses a modifier with 96110 to indicate whether a screening was positive or negative.
  • At least six states (ME, MN, MS, PA, TX, and WI) also use 96110 for autism screening and require the use of a modifier to distinguish the screening type.

Please email ehiggins@nashp.org with any updates to the map.

Legend:

Reimburses CPT 96110 (47)

Does not reimburse CPT 96110 (4)

State Medicaid Recommendations and Requirements for Developmental Screening Tools

Policy Trends

  • Thirty-five states require or recommend specific screening tools for developmental screening as part of a well-child visit.
  • Sixteen states do not recommend or require the use of specific developmental screening tools.

Sources: State Medicaid websites and direct communication with state Medicaid officials
Accurate as of January 2021

Legend:

Requires specific tools for CPT 96110 or developmental screening (18 states)

Recommends specific tools (19 states)

Does not recommend or require specific tools (16 states)

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