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6.3.19.3 Developmental Testing
Developmental testing (procedure code 96111) is a benefit of Texas Medicaid for clients who are birth through 20 years of age.
Developmental testing must consist of an extended evaluation and include the use of a standardized assessment tool. Developmental testing is medically necessary when there is suspected developmental delay supported by clinical evidence. Developmental testing is only medically indicated when clinical evidence suggests the following:
• Suspected developmental delay or atypical development cannot be clearly diagnosed through clinical interview or standardized screening tools alone
•Retesting of a client to evaluate a change in developmental status that results in a change of treatment plan
Procedure code 96111 is limited to two services per rolling year, any provider.
The procedure codes listed in the following table will be denied as part of another service when billed on the same day by the same provider as procedure code 96111:
Developmental testing performed when a development delay or a change in the client's developmental status is not suspected, is not a benefit of Texas Medicaid. Standardized testing (procedure code 96111) is not a benefit when completed to meet day care, Head Start, or school program requirements unless completed during an acute care visit in a clinic setting.
Providers cannot bill the client for developmental testing that is considered developmental screening.
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