Pediatric Coding Alert

Question: Our local Medicare carrier's rule has been that you could not bill 96110 multiple times with any modifier. The rule stated you could submit 96110 one time, per encounter, per day. Another coder said she thinks you can now include modifiers and submit multiple codes. Do you know if the instructions have changed?

Ohio Subscriber

Answer: CPT does not place any restrictions on the number of times you can bill 96110 (Developmental testing; limited [e.g., Developmental Screening Test II, Early Language Milestone Screen], with interpretation and report) can be billed. If the provider administers two or more separate standardized tests during the same visit, append modifier 59 (Distinct procedural service) to each additional 96110.

Example: Your provider completes the Vanderbilt parent and teacher follow-up forms for ADHD re-evaluation. Report 96110 for the parent form and 96110-59 for the teacher form.