Pediatric Coding Alert

Question: How many units can we report of 96110?  Our coder would like to report four units but that seems excessive. However, we did go over several tests and interpret them.

Alabama subscriber

Answer: Yes. Most practices charge for multiple units for MCHAT and depression/mood testing forms using 96110 (Developmental screening, with interpretation and report, per standardized instrument form). While some payers will reimburse you for more than one unit of the code on the same date of service, others might challenge you.

Because you will be using these tests to determine a patient’s treatment plan, you can argue to the insurer that they are medically necessary instruments in the event of a denial. Create an appeal letter in which the pediatrician shares the medical necessity of the tests.

Some payers have specific rules about reporting 96110 more than once on the same date. For instance the South Carolina Medicaid website advises, “When billing a CPT® code 96110 with 2 to 5 units per date of service, use modifier 59.”