Is developmental screening covered by insurance?
Usually yes, and usually free. Most plans cover the milestone questionnaire as preventive care at the 9, 18 and 30 month checkups, plus autism screening at 18 and 24 months. Code 96110 is the scored questionnaire a parent fills out and the office reviews, billed separately from the checkup.
$0 preventive
Free at the 9, 18 and 30 month visits
Two at 18 months
The 18 month visit often carries a milestone screen and an autism screen, which is two units of the same code on one claim.
Scored, not asked
Payers want a named tool that gets scored and filed. Questions asked in conversation and typed into the note do not support this code.
Modifier 25 trap
Modifier 25 belongs on the checkup line, not on the screening line. Putting it in the wrong place is one of the most common denials here.
Parent asks first
Families expect a free checkup and read a separate screening line as a surprise. Check plan status and the deductible left before they arrive.
What would a real check show for this patient's 96110?
Pick a sample plan and type your per-screening fee. This is the visibility a real-time check gives the desk for every actual patient, in under a second.
Eligibility readout · 96110
Sample- Coverage
- Active, preventive services with no cost share
- Frequency
- Milestone screens at 9, 18 and 30 months, autism at 18 and 24
- Patient share
- Type your fee to see it
Estimate from a sample plan. A real check reads the actual plan in under a second.
When 96110 is the right code
- A named screening tool was given and scored
- The score is filed in the child's record
- Billed with the well visit, not instead of it
- One unit for each separate tool used
Documentation payers expect
Keep the completed form or its score in the chart with the date and the tool's name, since payers ask for it on review. The well visit line usually needs modifier 25 to keep both services paid.
Why developmental screening gets denied
What happens after the screening
A screen that flags something leads to a longer visit, and full developmental testing bills as 96112, which many plans put behind a prior authorization and the deductible. Hearing and vision checks at the same visit add 92551 and 99173. A referral to speech or early intervention may need to be on file before the plan pays. Knowing plan status, the deductible left and any referral flag first keeps that next step from stalling.
96110, quick answers
Why is there a separate charge on a free checkup?
The screening is its own scored service, so it bills on its own line. In network it is normally covered at 100% as preventive care, so the line shows but the balance does not.
Which visits include it?
Most plans follow the well visit schedule, with milestone screens around 9, 18 and 30 months and autism screening at 18 and 24 months.
What if a child needs the questionnaire more than once a year?
Extra screens still belong in the chart, but many commercial plans pay one a year and treat the rest as part of the visit. State Medicaid programs are usually more generous.
Does Medicare pay 96110?
No. Medicare has no benefit for childhood developmental screening, so the code is not payable there. A young adult still on a parent's commercial plan is a different story.
Does a screening at a sick visit still get paid?
Sometimes, but plans expect it at the well visits. Screens outside those ages and visit types are the ones that come back as not covered.
More questions? Schedule 15 minutes with us and bring your toughest plan.
Every well child visit verified before the questionnaire goes out.
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Related: 96112 · 96127 · 96160
CPT is a registered trademark of the American Medical Association. This page is Valian's own plain-English summary for front-desk teams, not official CPT descriptor text, and is not billing or clinical advice. Coverage patterns are common plan behaviors; every plan differs. Verify benefits before the visit.