Screening
Early identification and treatment of children at risk for developmental delay is critical to helping them achieve their full potential in life.
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.
Reimbursement
Medicaid Fee for Service Reimbursement for Developmental Screening
Legend:
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.
Policy Trends
- 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.
Please email ehiggins@nashp.org with any updates to the map.
Developmental Screening Tools
State Medicaid Recommendations and Requirements for Developmental Screening Tools
Legend:
Requires specific tools for CPT 96110 or developmental screening (18 states)
Recommends specific tools (15 states)
Does not recommend or require specific tools (17 states)
* Note: Washington, DC is not pictured on the map, but is included in the counts above. It does not recommend or require specific tools.
Policy Trends
- 33 states recommend or require the use of specific tools for developmental screening
- 11 of these states refer to AAP Bright Futures Guidelines for tools
- 1 state that does not reimburse 96110 (New York) recommends that providers use specific tools for developmental screening. Hawaii also had this reimbursement policy until 2015.
- 17 states do not recommend or require the use of specific developmental screening tools
- The most commonly required or recommended tools include the ASQ (Ages and Stages Questionnaires) and PEDS (Parents Evaluation of Developmental Status).