Oregon Department of Human Services

Oregon ABCD Early Childhood Screening Initiative

Oregon Health Plan Reimbursement Policies for

Developmental Screening for Young Children

The Oregon Health Plan (OHP) has alwaysreimbursed CPT code 96110 for physiciansinterpreting developmental screening tools.Nevertheless, OHP's list of funded services were updated to make explicit thereimbursement of96110 at well-child visits for all young children on OHP.

As of April 1, 2008, providers may bill for each screening in any preventive care visit (including hearing, developmental, behavioral and/or psychosocial screens) to CPT code 96110. This furthers the pathway for providers to integrate standardized developmental screening tools in periodic well child visits for early identification of developmental delays in young children.

These changes reflect recommendations made by the American Academy of Pediatrics (AAP) policy statement issued in July 2006[1]. The AAP recommends all pediatric health professionals incorporate periodic developmental surveillance and standardized screening into their practice. The Oregon ABCD Screening Initiative recommends surveillance at every visit and a periodicity of standardized screening at 9 (or 12), 18, 24 (or 30), and 36 months of age, or whenever a parent, other caregiver, or clinician expresses concerns.

In accordance with the AAP Policy Statement, the ABCD Screening Committee recommended that providers bill to the 96110 code for office costs associated with parent (non-physician)-completed screening tools that are standardized, reliable, and validated. In addition, CPT code 96110 can be billed in addition to other CPT codes, such as evaluation and management (E&M) codes or preventive visit codes, on Line 3 of the Prioritized List of Health Services.

Additionally, certain standardized developmental screens are included in the Health Services Commission's(HSC) Prioritized List of Health Services Practice Guidelines Prevention Tables. The HSC adopted into the OHP Prevention Tables the Steering Committee’s recommendations for standardized, parent-report screening tools to include (but not limited to):

  • Ages and Stages Questionnaire (ASQ)
  • Parents Evaluation of Developmental Status (PEDS), with or without the PEDS: Developmental Milestones (DM)
  • Ages and Stages Questionnaire plus Social-Emotional (ASQ-SE)
  • Modified Checklist for Autism in Toddlers (M-CHAT)

For more information:

OHP Prioritized List of Health Services; Prevention Tables and Guidelines:

OHP Tools for Providers:

Oregon ABCD Screening Initiative:

Oregon ABCD: Implementing screening, surveillance and referrals:

[1]“Identifying Infants and Young Children with Developmental Disorders in the Medical Home: An Algorithm for Developmental Surveillance and Screening”, AAP Policy Statement, Pediatrics, July 2006.

Rev. 10/2009