Structured Screening for Developmental Delays and Autism Spectrum Disorders

The American Academy of Pediatrics (AAP) and other recognized medical organizations have established intervals from Developmental Surveillance and Screening Patient Care,  to conduct developmental surveillance and screening for developmental delays and Autsim Spectrum Disorders (ASDs). According to the AAP, structured screening for developmental delays and ASDs is the use of standardized, scientifically validated tools to identify and refine a recognized risk.

Providers should conduct structured screenings to identify additional risk factors by targeting specific developmental milestones in language and cognitive abilities, fine and gross motor skills, and social interactions, as well as signs and symptoms of ASDs. Providers should also conduct structured screening outside of the recommended screening periods if medically necessary.

Network providers can reference the chart below when conducting structured screening for Highmark Wholecare members:

When the validated screening tool identifies that the child needs further assessment, a diagnostic evaluation should be performed by the provider or by referral to an appropriate specialist or the Early Intervention Program. Providers can refer to the Early Intervention Program or for services through the local area Intermediate Unit by contacting the CONNECT Helpline at 1-800-692-7288 or accessing the Early Intervention Referral Form.

Billing

All Early Periodic Screening, Diagnostic, and Treatment (EPSDT) screening services must be reported with the age-appropriate evaluation and management code along with the EP modifier.

EPSDT Screening CPT Codes:

• 1 month to 11 month EPSDT visit CPT Code is 99381 or 99391.
• 12 months to 4 years EPSDT visit CPT Code is 99382 or 99392. The CPT code for Developmental Screening is 96110.
• The CPT code for Autism Screening is 96110 U1.

For questions regarding the EPSDT program, please contact  EPSDTinfo@HighmarkWholecare.com.

These codes are not all encompassing and use does not guarantee payment. They are intended as a guide to provide education around appropriate screenings and coding as part of the EPSDT program.