19-1011 Include ASD Screening during Well-Child Visits
Date: 12/30/19
19-1011/OTH037842EH0 (12/19)
Include ASD Screening during Well-Child Visits
Developmental screenings help with early detection of any issues
The first developmental screening should be at nine months with follow-up screenings at 18 months, and 24 or 30 months. Specific screenings for autism should be included for all children starting at ages 18 and 24 months. The autism spectrum disorder (ASD) screening can be done when performing developmental screenings at the same well-child visits.
The different developmental screenings are vital to successful treatment and positive impact for a child’s well-being.
Coding for developmental screenings
CPT code 96110 must be billed with modifier KX to indicate screening for ASD at ages 18 months and 24 months. Note: Screening for ASD is different from general developmental screenings.
Screening type
Use CPT code
With modifier
ASD
96110
KX
Developmental – general
None required
CPT 96110 is coded with other outpatient evaluation and management (E/M) services on claims and encounters, with or without modifier KX.
Symptoms in three core areas
ASD can show delays, regression or deficits in these areas:
• Social communication and interaction.
• Verbal and nonverbal communication.
• Restricted repetitive patterns of behavior, interests and activities.
About the M-CHAT questionnaires
Recommended tools for ASD screening are the Modified Checklist for Autism in Toddlers (M-CHATTM) and the Revised with Follow-up (M-CHAT-R/FTM). Both can be used by specialists or other professionals to assess risk for ASD.
• Parent(s) completes 23 questions for M-CHAT or 20 questions for M-CHAT-R/F.
• Takes about 10 minutes to complete and two minutes to score.
• Translations of the questionnaires are available in different languages.
Where to find screening tools
Screening tools do not give final proof of developmental delays and do not result in diagnoses. Follow a positive screening result with a thorough assessment.
You can find resources and tools on the following websites:
• Official M-CHAT™ at https://mchatscreen.com – questionnaires, scoring and more.
• M-CHAT.org at https://m-chat.org – free online screening test with instant scoring for children between ages 16 and 30 months. A PDF version is also available for the M-CHAT-R/F.
• American Academy of Pediatrics (AAP) –
- Screening Tool Finder with categories, topics covered and links at https://screeningtime.org/star-center/#/screening-tools#top.
- Links to commonly used screening instruments and tools at https://toolkits.solutions.aap.org/selfserve/ ssPage.aspx?SelfServeContentId=screening_tools.
References
To learn more about autism and child development, go to these websites:
• www.cdc.gov/ncbddd/childdevelopment/screening.html.
• www.hhs.gov/programs/topic-sites/autism/index.html.
• www.cdc.gov/ncbddd/autism/data.html.
• www.cdc.gov/ncbddd/autism/research.html.
Additional information
Providers are encouraged to access California Health & Wellness Plan’s (CHWP’s) provider portal online at www.CAHealthWellness.com for real-time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more.
If you have questions regarding the information contained in this update, contact CHWP at 1-877-658-0305.