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96112 CPT code

96112 CPT code, CPT code 96112

96112 CPT code in occupational therapy includes a developmental test administration of fine and gross motor, language, cognitive level, social, memory, and executive functions by standardized instruments when performed by a qualified healthcare professional, with interpretation and report, first hour.

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For an additional 30 minutes, therapists can use CPT code 96113. For occupational therapists, understanding the 96112 CPT code facilitates effective collaboration with other healthcare professionals, ensures accurate billing and reimbursement, supports compliance with healthcare regulations, and ultimately enhances the quality of patient care.

The AMA has updated guidelines over time to meet the ever-changing healthcare needs.



Key features of 96112 CPT code

The primary focus is on developmental areas, including gross motor, fine motor, cognitive, language, social, and adaptive functioning skills, with administration, interpretation, and documentation of results.

A qualified professional should administer tests and include the following:

Bayley Scales of Infant and Toddler Development

  • A comprehensive formal developmental assessment for diagnosing developmental delays in early childhood

  • Ages: 16 days - 23 months and 24-42 months

 

Vineland Adaptive Behavior Scales

  • It uses a semi-structured interview to measure adaptive behavior and support the diagnosis of developmental delays, intellectual and developmental disabilities, or autism.

  • Ages: 0-90 years and for teacher rating form 3-21 years

 

Development Assessment of Young Children (DAYC):

  • Gather information about a child’s abilities through observation, caregiver interviews, and direct assessment.

  • Ages: Birth to 5 years


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Application of CPT code 96112 in occupational therapy

An example of utilizing code 96112 CPT code would include a child exhibiting behaviors consistent with autism spectrum disorder (ASD), who is having difficulties at school with social interactions, communication, and repetitive behaviors.

Therapists obtain the history and occupational profile. According to the University of Washington, tests are administered for 90 minutes with scoring, interpretation, and report building accounting for an additional 60 minutes, with a concise report also generated for school.

Use 96112 CPT code and 96113 CPT codes. The 96112 CPT code takes into account the first 76 mins of the total time of 150 mins for developmental testing/interpretation, and 96113 with 3 units. The addition of 3 units account for the remaining 74 mins of developmental testing/interpretation.

Depending on insurance regulations, modifiers may be required.


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Documentation standards and best practices

Ensuring precise and accurate documentation for the 96112 CPT code is essential for proper billing and reimbursement.

Some general pitfalls to avoid during documentation include:
  • Incorrect billing information
  • Clerical errors such as typos
  • Not enough documentation information
  • Using incorrect codes

Additionally, for CPT codes 96112 and 96113, it is important to document time, tests used, and patient interaction observations. It is also best practice to be mindful of specific payer regulations and follow AMA and CMS guidelines.

Billing and documentation tips for billing 96112 CPT code

Interpretation and documentation of results must include the following:
  • Qualified professional information and supervision information

  • Assessment tool information

  • Time-based billing information

  • Clinical reasoning and medical necessity

  • Date of screening

  • Report with screening results, scores, clinical interpretation, and recommendations

  • Patient/caregiver communication

Additionally, therapists should stay compliant with AMA and CMS guidelines.

Step-by-step process for administering extended developmental testing

  • Review occupational profile and history, obtain consent, and explain the purpose of testing and the steps of the process.

  • Select, prepare, and administer appropriate standardized assessment tool

  • Record observations and interpret scores and results

  • Identify areas of concern and need

  • Communicate findings to caregivers and collaborate with caregivers on an intervention plan

  • Set SMART goals

  • Set client-centered intervention methods

  • Offer resources and support networks

  • Coordinate with other healthcare professionals

  • Re-assess and re-evaluate as necessary



Ethical and professional considerations

Ensuring ethical and professional standards in extended developmental testing incorporates using appropriate standardized tools, adhering to professional guidelines, maintaining confidentiality, obtaining informed consent, and communicating appropriately and effectively with caregivers and family members.

It also involves awareness of one’s biases, utilizing non-discriminatory principles, inclusive practice methods, and cultural sensitivity. By following these principles, therapists can provide client-centered care and high standards of care.

Challenges and limitations with the 96112 CPT code

Some common challenges and limitations with using the 96112 CPT code include test performance variability due to anxiety, medication, fatigue, time constraints, resource limitations or test complexity, and education and training.

Some strategies to assist with the limitations include continuing education and training, utilizing culturally appropriate tools, communication with parents and caregivers, time management strategies, and regular review of insurance policies. With these practices, therapists can overcome these challenges to ensure that children receive accurate assessments promptly.

Future trends and developments

Some emerging trends and research in developmental testing include more of a personalized approach to testing, expansion of developmental conditions, enhancement of documentation requirements, development of new and updated assessments, use of telehealth services and platforms, incorporating the use of artificial intelligence and machine learning and the use of digital and mobile screening tools.

With these future trends and developments, healthcare professionals can leverage technology to provide improved client-centered and holistic care in a timely and accurate manner.

In summary, the 96112 CPT code plays a crucial role in occupational therapy by allowing comprehensive and standardized developmental assessments for the pediatric population.

It allows for accurate billing, guides targeted interventions, and delivers foundational information to families and caregivers. Integrating and incorporating the 96112 CPT code into clinical practice is essential for providing high-quality, client-centered, and evidence-based occupational therapy services.


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How EHR and practice management software can save you time with insurance billing for therapists

EHRs with integrated billing software and clearing houses, such as TheraPlatform, offer therapists significant advantages in creating an efficient insurance billing process. The key is minimizing the amount of time dedicated to developing, sending, and tracking medical claims through features such as automation and batching.

What are automation and batching?

  • Automation refers to setting up software to perform tasks with limited human interaction.

  • Batching or performing administrative tasks in blocks of time at once allows you to perform a task from a single entry point with less clicking.

Which billing and medical claim tasks can be automated and batched through billing software?

  • Invoices: Create multiple invoices for multiple clients with a click or two of a button or set up auto-invoice creation, and the software will automatically create invoices for you at the preferred time. You can even have the system automatically send invoices to your clients.

  • Credit card processing: Charge multiple clients with a click of a button or set up auto credit card billing, and the billing software will automatically charge the card (easier than swiping!)

  • Email payment reminders: Never manually send another reminder email for payment again, or skip this altogether by enabling auto credit card charges.

  • Live claim validation: The system reviews each claim to catch any human errors before submission, saving you time and reducing rejected claims.

  • Automated payment posting: Streamline posting procedures for paid medical claims with ERA. When insurance offers ERA, all their payments will post automatically on TheraPlatform's EHR.

  • Tracking: Track payment and profits, including aging invoices, overdue invoices, transactions, billed services, service providers.

Utilizing billing software integrated with an EHR and practice management software can make storing and sharing billing and insurance easy and save providers time when it comes to insurance billing for therapists.



TheraPlatform is an all-in-one EHR, practice management, and teletherapy software built for therapists to help them save time on admin tasks. It offers a 30-day risk-free trial with no credit card required and supports different industries and sizes of practices, including occupational therapists in group and solo practices.


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