Section 6

In 2003, the Centers for Medicare and Medicaid Services approved two CPT codes

Reimbursement

related to child development   96110 for developmental screening and 96111 for

developmental testing   thereby forging a path for reimbursement for the services

for

covered by these codes.

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Health plans can encourage delivery of standardized

developmental screening by reimbursing providers for codes 96110 and 96111 in

Developmental

addition to reimbursement for preventive visits.  Several BCAP Workgroup partici 

pants   Lovelace, Health Plus, Virginia Premier, Managed Health Services, DC

Screening and

Chartered, and BCBST   implemented or reinforced provider incentives as a part

of their pilot projects.

Testing 

Lovelace Community Health Plan

In New Mexico, both health risk assessments and developmental questionnaires

were considered part of the EPSDT exam and were not reimbursed separately.

Lovelace approached the Medicaid Department of the Health and Human Services

Department (DHHS) and requested permission to reimburse for use of the ASQ

screener.  Initially, DHHS determined that Lovelace would not receive extra reim 

bursement from the state and thought that Lovelace could reimburse for the ASQ

screener as an enhancement to its services.

The Lovelace BCAP team presented an economic justification to the Medical

Director of Lovelace Health Plan.  They showed that the average age of referral to

the Family Infant Toddler program was 17 months and that most children were in

the program for two years.  They convinced the leadership at Lovelace that encour 

aging early screening through the ASQ could possibly improve the early referral

rate to FIT and save unnecessary costs on more complex therapies and services at a

later age.  Lovelace saw the potential to reduce costs to the health plan and decid 

ed to pilot a reimbursement of $10 per questionnaire at the pilot sites.  This incen 

tive led to improved screening and referral rates and, as a result, the reimbursement

was expanded to all Medicaid providers at Lovelace.  In addition, Lovelace went

back to DHHS and convinced state policy makers to reimburse an additional

amount ($14) for standardized developmental testing.

Health Plus

Health Plus sought to increase physician awareness of the need for developmental

screenings as part of well child visits and added an incentive of $25 for physicians

who submitted claims for developmental screening and testing.  The plan promoted

this new incentive through letters to providers serving children at risk for develop 

mental delay and also through two articles in a quarterly provider newsletter. The

plan reports that these efforts doubled their developmental screening claims during

their pilot phase.  There was also a 26 percent increase in preventive visits for chil 

dren between the ages of 12 months and four years. Through the pilot project,

Health Plus learned that increasing physician awareness and providing monetary

incentives can help ensure that infants receive developmental screening as part of

the preventive exam.  Because of the success of the pilot project, Health Plus per 

manently extended the intervention to all providers.

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M. Macias and L. Wegner,  Coding Conundrums   Screening and Developmental Testing Codes,  March 2005, www.dbpeds.org/articles/detail.cfm?TextID=384.

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