Billing & Coding

Developmental and Mental Health Care Billing and Coding

CPT codes for billing standardized screening and assessment of developmental, social-emotional, mental health or family risks are as follows:

Developmental and Mental Health Surveillance

Surveillance of a child’s development, behavior, social-emotional status and family risk factors is considered to be an integral part of the EPSDT screening exam and, as such, cannot be billed as an independent service.

Developmental Screening

Use of a standardized developmental screening tool with interpretation and report, such as the recommended ASQ-3, may be billed in addition to the preventive medicine services code or any other evaluation and management service. In order for the test to be billed as a separate service, the interpretation and report must be a significant, distinct service. Use the limited development testing code: 96110

Autism Screening

Use of a standardized autism screening tool with interpretation and report, such as the recommended M-CHAT R/F, may be billed in addition to the preventive medicine services code or any other evaluation and management service. In order for the test to be billed as a separate service, the interpretation and report must be a significant, distinct service. Use the limited development testing code: 96110

Caregiver Depression Screening

Use of a standardized caregiver depression screening tool with interpretation and report, such as the recommended Edinburgh Postnatal Depression Scale or the PHQ-9, may be billed as a separate service. Use code: 99420

Please note that the 2-question PHQ-2 is considered surveillance and a part of the regular EPSDT screening exam. As such, it may not be billed as an independent service.

Adolescent Depression Screening

Use of a standardized depression screening tool with interpretation and report, such as the recommended PHQ-9, may be billed as a separate service. Use code: 96127

Please note that the 2-question PHQ-2 is considered surveillance and a part of the regular EPSDT screening exam. As such, it may not be billed as an independent service.

Alcohol and Drug Use Screening

Use of a standardized alcohol and drug use screening tool with interpretation and report, such as the recommended CRAFFT, may be billed as a separate service. Use code 96110

Coding Decisions

Assistance in deciding on appropriate CPT billing codes for emotional and behavioral assessment is provided by the American Academy of Pediatrics.

Find the AAP Coding Corner article online in the January 2015 issue of AAP News.

Commonly Used Coding

Pediatric Preventive Care

The American Academy of Pediatrics provides comprehensive listings of codes for 2022. They recommend practices identify the most commonly used codes, and create a billing sheet for easy reference.

Coding Strategies

Assessment and Diagnosis of Developmental, Behavioral and Social-emotional Concerns

Providers are encouraged to use ICD-10 diagnostic codes whenever those codes are appropriate and reasonable. However, DSM IV psychiatric diagnoses sometimes do not fit well for the problems of young children and their families, and the mental health interventions to serve them.

The Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC: 0-3) from Zero to Three provides a promising practice model for the assessment of infants, young children and parent-child relationships. However, many payers do not yet recognize DC: 0-3 coding alone.

Have questions?

On April 1, 2016, pending final federal approval, the Iowa Department of Human Services (DHS) will be transitioning most Iowa Medicaid members to a new managed care program called IA Health Link. Until the transition occurs, questions should be directed to Provider Services at:

800-338-7909 (Toll free)
515-256-4609 (Des Moines area)
515-725-1155 (Fax)

Provider Services
P.O. Box 36450
Des Moines, IA 50315

For more information regarding the Iowa Medicaid transition to managed care, please read the IA Health Link Managed Care Program Provider Toolkit or the IA Health Link Frequently Asked Questions. You will also find more provider-specific information regarding the managed care transition on the Medicaid Modernization web page.