Developmental Screenings and Surveillance

Providers

Early identification of developmental disorders is critical to the well-being of children and their families.

It is an important function of primary care and the responsibility of all pediatric healthcare professionals.

The American Academy of Pediatrics (AAP) recommends that developmental surveillance be incorporated at every well-child preventive care visit from infancy through school age, and at any age thereafter if concerns are raised about social acceptance, learning or behavior.

If developmental problems are identified, further developmental and medical evaluation, diagnosis, and treatment, including early developmental intervention should be conducted. Children diagnosed with developmental disorders should be identified as children with special needs and chronic-condition management should be initiated.

Developmental Screenings and Surveillance

The Department of Human Services (DHS) requires all Medicaid providers to screen for developmental delays and autism spectrum disorders (ASDs). These requirements have also been integrated into Pennsylvania's EPSDT program.

Our providers must document all surveillance, screening and referral activities, and include a copy of the validated developmental or autism screening tool used to conduct the screening. Providers may use any validated screening tool.

We routinely review medical records, and we will audit this component to ensure compliance as required by the state. Compliance will be established only if both the flow sheet and the completed tool are included in the medical record.

Guidelines for Developmental Screenings in Pediatric Care

According to the American Academy of Pediatrics (AAP), standardized developmental screenings should be conducted at the 9-, 18-, and 30-month well-child visits. In addition, physicians should administer a screening for ASDs during the 18- and 24-month health supervision visits.

Early identification of developmental disorders is critical to the well-being of children and their families. It is an important function of primary care and the responsibility of all pediatric healthcare professionals. 

AAP recommends that developmental surveillance be incorporated at every well-child preventive care visit at the recommended age ranges, and at any age thereafter if concerns are raised about social acceptance, learning or behavior.

If developmental problems are identified, further developmental and medical evaluation, diagnosis, and treatment, including early developmental intervention should be conducted.

Children diagnosed with developmental disorders should be identified as children with special needs, and chronic-condition management should be initiated. 

Compliance Tools

Validated Tools for Developmental Monitoring and Screening

Timeframe: 9 months, 18 months, 30 months

Developmental screening is more in-depth than monitoring and may help identify children with a developmental risk that was not identified during developmental monitoring.

The Pennsylvania Department of Human Services (DHS) and the Pennsylvania EPSDT program requires all Medicaid providers to screen for developmental delays during well-child visits.

Providers must document all surveillance (monitoring), screening and referral activities, and must include a copy of the validated development tool used to conduct the screening.

Milestone Tracking

Timeframe: Varies

Resources:

For providers: https://www.cdc.gov/ncbddd/actearly/hcp/index.html
For parents: https://www.cdc.gov/ncbddd/actearly/milestones/index.html

It is important for clinicians to teach parents and caregivers to recognize developmental milestones. Research has confirmed that parents are reliable sources of information about their child’s development. Parents who are aware of developmental milestones can observe their child and inform their healthcare provider about any concerns they may have about their child’s development. Pediatric healthcare providers can provide parents with milestone checklists to track their child’s milestones at home.

Quality Care Plus Program

If your practice participates in our Quality Care Plus (QCP) primary care incentive program, your incentive payout correlates to the percentage of lead screenings performed in children before their second birthday and percentage of children screened for developmental delays in children 0-3 years of age.

Developmental Screening in the First Three Years of Life
Measure Description	The percentage of patients 0-3 years of age who were screened for risk of developmental, behavioral and social delays using a standardized screening tool in the first three years of life. Please note that this measure includes three age-specific indicators assessing whether children are screened by their first, second or third birthday.
Product Line	Medicaid
Eligible Patients	Based on age only. Patients who turn 3 years old during the measurement year are included.
Exclusions	None
Telehealth Allowance	None
Tips to Improve Performance	Ensure that you are using a standardized, validated screening tool. When billing with CPT code 96110, ensure that your documentation includes confirmation that the screening was completed using a standardized tool, the results and any actions taken. Connect patients to our Healthy Kids program. Review our member level reports in our provider portal to identify noncompliant members.
Codes for Compliance	Developmental testing, with interpretation and report	CPT	96110

CPT Coding

Provider offices should use CPT codes 96110 and 96127, which are the correct codes for developmental screenings and emotional and behavioral assessments. If you identify issues in children and young adults under age 21, you should utilize the standard assessment tools and include the CPT codes in your claim submissions.

Code	Definition	Frequency
96110	Developmental screening with scoring and documentation per standardized instrument.	Limited to a frequency of 3 units per date of service for children and young adults up to 21 years of age.
96127	Brief emotional/behavioral assessment with scoring and documentation per standardized instrument.	Limited to a frequency of 3 units per date of service for children up to 12 years and older.

For More Information

We are happy to answer any questions you may have regarding this requirement or any Health Partners Plans program. Please contact our Provider Services Helpline at 888-991-9023.