96113

Developmental test administration (including assessment of fine and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified health care professional, with interpretation and report; each additional 30 minutes

CPT code 96113 is a time-based add-on code used to report each additional 30 minutes of developmental test administration performed by a physician or other qualified health care professional. This code must exclusively be reported in conjunction with the primary base code 96112, which captures the first hour of the testing evaluation. Developmental testing utilizes comprehensive, standardized instruments to thoroughly evaluate a patient's fine and gross motor skills, receptive and expressive language development, cognitive levels, social-emotional interactions, memory capabilities, and executive functions. Common examples of these standardized instruments include the Bayley Scales of Infant and Toddler Development, the Peabody Developmental Motor Scales, and the Clinical Evaluation of Language Fundamentals. The service involves the physician or qualified healthcare professional actively administering these tests, directly observing the patient's performance, and systematically recording their responses in a controlled clinical environment. Beyond the direct face-to-face administration time with the patient and caregivers, the time captured by CPT code 96113 also encompasses the extensive professional work required to score the assessments, integrate the testing findings with the patient's comprehensive medical, family, and developmental history, interpret the standardized test results in comparison to age-matched normative data, and formulate a detailed written report. This comprehensive report outlines the patient's current developmental status, identifies any specific delays or neurodevelopmental disorders such as autism spectrum disorder, intellectual disabilities, or specific learning disorders, and provides actionable recommendations for early intervention or specialized therapies. Because 96113 is a time-based add-on code, strict adherence to time documentation guidelines is absolutely critical. The primary code 96112 covers the initial 60 minutes of service. To appropriately report a single unit of 96113, the total time spent must exceed the first hour by a minimum of 16 minutes, meaning the provider must have engaged in at least 76 minutes of total developmental testing, interpretation, and reporting time. Subsequent units of 96113 may be reported for each additional full 30-minute block or fraction greater than 15 minutes. It is vital to differentiate this in-depth developmental testing from routine developmental screening (such as CPT 96110), which is typically performed using a simple standardized screening tool during a preventative well-child visit and lacks the extensive interpretation and detailed reporting required by the 96112 and 96113 code set. This code serves a fundamental role in pediatric neurology, developmental-behavioral pediatrics, and early childhood psychology for establishing baseline abilities, longitudinally tracking developmental progress, and justifying the medical necessity for ongoing therapeutic interventions like speech, occupational, and physical therapies.

Clinical Indications

  • Suspected or identified global developmental delay in infants and children
  • Screening, evaluation, and diagnostic clarification of autism spectrum disorder (ASD)
  • Assessment of suspected intellectual disability or severe cognitive impairment
  • Evaluation of specific language impairment or expressive/receptive language delays
  • Assessment of fine or gross motor skill deficits, including cerebral palsy or hypotonia
  • Routine follow-up and developmental monitoring of high-risk infants, such as those born prematurely or with low birth weight
  • Evaluation of developmental progression in children with known genetic anomalies or metabolic disorders
  • Assessment of social, emotional, or behavioral delays impacting early childhood development

Procedure Steps

  1. Review the patient's comprehensive medical, developmental, and family history prior to test administration
  2. Select appropriate standardized developmental instruments based on the patient's age and suspected developmental deficits
  3. Engage the patient and caregivers in a controlled clinical setting to administer the standardized developmental tests
  4. Observe and record the patient's responses, behaviors, and interaction patterns during the testing tasks
  5. Calculate raw scores from the administered instruments and convert them into standardized scores or percentiles based on normative data
  6. Analyze and interpret the standardized test scores in the context of the patient's clinical history and direct observations
  7. Formulate clinical conclusions regarding the presence and severity of any developmental delays or neurodevelopmental disorders
  8. Draft a comprehensive, formal written report detailing the assessment methodologies, results, clinical interpretations, and individualized treatment recommendations
  9. Document the exact total time spent on face-to-face administration, scoring, interpretation, and report preparation to justify the use of time-based codes 96112 and 96113

Coding Guidelines

  • CPT 96113 is an add-on code and must be billed in conjunction with the primary code 96112.
  • Do not report 96113 for less than 16 minutes of additional time beyond the first hour. Total time must be at least 76 minutes to report 96112 and one unit of 96113.
  • Time calculations include both face-to-face time with the patient/caregiver and non-face-to-face time spent scoring, interpreting, and writing the report.
  • Do not report 96113 in conjunction with 96110 (developmental screening) if the screening is the only service provided.
  • Documentation must explicitly state the total time spent on the evaluation to support the billed units.
  • If the testing is performed by a technician rather than a physician or QHP, refer to the technician testing codes (e.g., 96121) rather than 96113.
  • Do not use 96113 for psychological or neuropsychological testing; use the appropriate codes (e.g., 96130-96133, 96136-96139) for those specific services.

Associated ICD-10 Codes