TMPPM 2010 > Children's Services Handbook > THSteps Medical > Services/Benefits, Limitations, and Prior Authorization > Screening Components With Additional Requirements > Developmental Screening

6.3.2 Screening Components With Additional Requirements

6.3.2.1 Developmental Screening

Developmental screening is a required component of every checkup for clients who are birth through 6 years of age.

As a THSteps medical service, developmental screenings (procedure code 96110) or autism screenings (procedure code 96110 with modifier U6) is limited to once per day per client by the same provider or provider group and will be denied unless submitted by the same provider or provider group for the same date of service as a checkup, exception-to-periodicity checkup, or follow-up visit.

For clients who are 9 months through 4 years of age, the medical checkups must include a standardized developmental screen. Providers must use a standardized tool when performing a developmental or autism screening. A standardized screen is not required at other checkups up to and including the 6-year checkup; however, developmental screening is required at these visits and includes a review of milestones (gross and fine motor skills, communication skills, speech-language development, self-help/care skills, and social, emotional, and cognitive development) and mental health and is not considered a separate service.

Providers may be reimbursed for the recommended screening tools listed in the table below in addition to the checkup visit at specific age visits. THSteps accepts the following recommended standardized tools at the following ages:

Through August 31, 2011, providers may choose to use a standardized screening tool that is not listed in the Required Screening Ages and Recommended Tools table to complete the requirements of a medical checkup visit; however, providers may not submit a claim for a tool that is not listed in the table. If a standardized screen that is not listed is billed, it will be subject to recoupment.

Autism screening is required at 18 months of age.

If a developmental or autism screening that is required in the Required Screening Ages and Recommended Tools table is not completed during a checkup, the provider must document the reason why the screening was unable to be completed and schedule a follow-up appointment to complete the screening as soon as possible..

The provider must also complete a standardized screening when seeing a client who is 6 months through 6 years of age for the first time at any checkup.

If a provider administers a standardized developmental screening at additional checkups other than those listed in the Required Screening Ages and Recommended Tools table, the provider must document the rationale for the additional screening, which may be due to provider or parental concerns.

Developmental screening that is completed without the use of one of the recommended standardized screening tools is not a separately payable benefit.

Clients who are birth through 35 months of age with suspected developmental delay must be referred to ECI within 2 working days or identification even if referred to an appropriate provider for further testing. If the client is 3 years of age or older, referral should be made to the local school district special education program.

Standardized developmental screening may be performed outside a THSteps medical checkup as part of development and neurological assessment and testing.

Refer to: Subsection 6.3.19, "Developmental and Neurological Assessment and Testing" in the Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook (Vol. 2 Provider Handbooks) for information related to developmental screening.

Administration of the Mini Mental State Examination (MMSE) is considered part of an E/M service and is not separately reimbursed.