CPT 96113: Developmental Testing Administration (Each Additional Hour) — A Complete Guide

CPT 96113 covers each additional hour of developmental testing performed by a physician or qualified health care professional and must be billed with CPT 96112, which represents the first hour. Developmental testing plays a vital role in identifying delays, disorders, and functional impairments in children and adolescents. Accurate coding, documentation, and billing of CPT 96113 ensure appropriate reimbursement while maintaining compliance with payer guidelines.

This guide covers what CPT 96113 includes, when to use it, time and documentation requirements, reimbursement details, compliance risks, and billing best practices.

Understanding CPT 96113

CPT 96113 is an add-on code that reports each additional hour of developmental testing administration beyond the first hour (96112). It reflects the provider’s direct, face-to-face professional time spent administering standardized developmental assessment tools and interpreting results in real time.

It cannot be billed alone. It must always be reported with:

• CPT 96112 – Developmental testing, first hour

What Is Developmental Testing?

Developmental testing evaluates a child’s cognitive, language, motor, adaptive, and social-emotional functioning. It is commonly used to assess:

• Developmental delays
• Autism spectrum disorder
• Intellectual disability
• Learning disabilities
• ADHD
• Speech and language delays
• Behavioral concerns
• Genetic or neurological conditions impacting development

Unlike brief developmental screenings, CPT 96112 and 96113 involve comprehensive, standardized testing administered by a qualified professional.

What Is Included in CPT 96113?

CPT 96113 covers each additional hour of face-to-face developmental testing administration performed by a physician or qualified health care professional, beyond the first hour billed under CPT 96112.

This code includes

• Administration of standardized developmental assessment tools
• Direct behavioral observation during testing
• Real-time scoring and clinical decision-making
• Ongoing interpretation of patient performance
• Adjustments to testing methods based on attention, behavior, or developmental level

CPT 96113 reflects extended professional time required when evaluating complex developmental concerns across multiple domains, such as cognitive, language, motor, adaptive, and social-emotional functioning.

It does not include

• Brief developmental screenings
• Non-face-to-face scoring
• Report writing performed after the session
• Technician-administered testing (which uses different CPT codes)

CPT 96113 must always be reported with CPT 96112 and cannot be billed independently.

When to Use CPT 96113

CPT 96113 is appropriate when developmental testing exceeds the first hour due to:

• Complex developmental presentations
• Multi-domain assessment requirements
• Behavioral dysregulation requiring extended observation
• Language barriers requiring modified testing
• Need for multiple standardized instruments
• Differential diagnosis between autism, ADHD, or intellectual disability

It should not be reported for:

• Brief screenings
• Parent questionnaires only
• Non-face-to-face scoring
• Report writing time

Who Can Bill CPT 96113?

CPT 96113 may be billed by:

• Developmental pediatricians
• Pediatric neurologists
• Child psychiatrists
• Clinical psychologists
• Neuropsychologists
• Other qualified licensed professionals acting within scope

State scope-of-practice laws and payer policies apply.

Time and Billing Requirements

CPT 96113 is a time-based add-on code and must be billed in conjunction with CPT 96112 (first hour). Proper time calculation is essential for accurate reimbursement and compliance.

Time Threshold

• CPT 96112 covers the first 31–90 minutes.
• CPT 96113 may be billed for each additional full hour of face-to-face developmental testing.
• At least 31 additional minutes beyond the first hour must be documented to report one unit of 96113.

Example

• Total face-to-face testing time: 2 hours and 20 minutes

Billing

• 96112 (first hour)
• 96113 (one additional hour)

If testing extends beyond two additional hours, multiple units of 96113 may be billed, provided time supports it.

What Counts Toward Time

• ✔ Direct face-to-face testing time
• ✔ Real-time scoring during administration
• ✔ Clinical adjustments made during testing

What Does Not Count

• ✘ Report writing after the session
• ✘ Non-face-to-face administrative tasks
• ✘ Technician-administered testing (uses separate codes)

Accurate time tracking and clear documentation are critical to avoid underbilling or audit risk.

Documentation Requirements

Accurate documentation is critical.

1. Time Documentation

• Include start and stop times or total minutes.

Example:

• Start: 8:30 AM
• Stop: 10:45 AM
• Total testing time: 135 minutes

2. Medical Necessity

• Document specific developmental concerns prompting evaluation.

3. Instruments Used

• List standardized tools administered (e.g., cognitive scales, language assessments).

4. Behavioral Observations

• Note attention, effort, cooperation, affect, and regulatory behaviors.

5. Clinical Interpretation

• Provide brief integration of findings supporting diagnostic formulation.

6. Plan

• Include recommendations for therapy, referrals, or further testing.

Incomplete time documentation is a leading cause of denials.

Clinical Scenarios

Scenario 1: Autism Evaluation

• A 4-year-old presents with speech delay and social deficits. Standardized testing includes multiple tools requiring over two hours of administration.

Billing

• 96112 (first hour)
• 96113 (one additional hour)

Scenario 2: Global Developmental Delay

• A toddler with motor and cognitive delays requires extended structured observation and adaptive functioning testing lasting 2.5 hours.

Billing

96112

96113

Reimbursement and Payer Considerations

Reimbursement for CPT 96113 varies based on payer contracts, geographic region, and provider credentials. Because it is an add-on code tied to extended testing time, proper billing directly impacts revenue.

1. Typical Reimbursement Range

CPT 96113 commonly reimburses between $100 and $180 per additional hour, depending on Medicare locality rates and commercial insurance contracts.

2. Medicare Payment

Medicare reimbursement is determined by the Physician Fee Schedule and adjusted by geographic factors. Rates may change annually, so providers should verify current fee schedules.

3. Commercial Insurance Rates

Commercial payers may reimburse at higher negotiated rates, but policies vary widely. Some plans impose limits on the number of hours covered per evaluation.

4. Prior Authorization

Many payers require prior authorization for developmental testing beyond the first hour. Failure to obtain authorization can result in claim denial.

5. Diagnosis Linking

The ICD-10 diagnosis must clearly support the need for extended developmental testing. Vague or non-specific diagnoses may trigger medical necessity denials.

Regularly reviewing payer policies, tracking reimbursement patterns, and confirming authorizations before services are rendered can significantly reduce revenue disruptions.

Audit and Compliance Considerations

CPT 96113 is often subject to payer review because it involves extended time and higher reimbursement. Strong compliance practices are essential to reduce audit exposure and protect revenue.

1. Demonstrate Clear Medical Necessity

Documentation must clearly explain why extended developmental testing was required. The clinical complexity should justify time beyond the first hour.

2. Ensure Accurate Time Reporting

Start/stop times or total face-to-face minutes must be clearly documented. The total time billed must align with the number of units reported.

3. List Standardized Tools Administered

Clearly identify the developmental instruments used during testing to support the scope and depth of the evaluation.

4. Differentiate From Other Services

If developmental testing is performed on the same day as an E/M service or other assessments, documentation must clearly separate each service.

5. Avoid Template Overuse

Generic or repetitive notes without individualized findings increase audit risk and may fail to support medical necessity.

Regular internal chart audits, billing reviews, and staff training can significantly reduce compliance issues and improve claim approval rates.

Telehealth Considerations

Developmental testing via telehealth may be allowed under certain payer policies. Requirements typically include:

• Real-time audio-video platform
• Use of validated remote tools
• Documentation reflecting telehealth delivery

Always verify payer rules before providing remote services.

Common Billing Errors

Because CPT 96113 is an add-on, time-based code, billing errors are common and can lead to denials or recoupments. Avoid the following pitfalls:

1. Billing 96113 Without 96112

CPT 96113 cannot be billed alone. It must always accompany CPT 96112 (first hour).

2. Insufficient Time Documentation

Failing to document at least 31 additional minutes beyond the first hour will not support reporting 96113.

3. Counting Non-Face-to-Face Time

Report writing, scoring after the session, and administrative tasks do not count toward billable time.

4. Using the Wrong Code for Technician Testing

If testing is performed by a technician, different CPT codes apply. 96113 is reserved for physician or qualified professional administration.

5. Lack of Medical Necessity

Extended testing must be justified by clinical complexity. Vague developmental concerns may result in denial.

6. Overbilling Additional Hours

Reporting multiple units of 96113 without clear time support increases audit risk.

To avoid costly errors and strengthen your reimbursement process, read Mistakes Leading to Claim Denials in Medical Billing.

Practical Workflow Tips for Developmental Testing

Efficient workflow management helps ensure accurate billing for CPT 96113 while maintaining high-quality patient care. Structured processes reduce errors and streamline reimbursement.

1. Verify Benefits Before Scheduling

Confirm coverage, authorization requirements, and any payer-imposed hour limits before initiating extended testing.

2. Obtain Prior Authorization When Required

Submit clinical documentation early to avoid delays or denials for additional testing hours.

3. Track Time in Real Time

Use EHR timers or manual logs during testing sessions to ensure precise time documentation for each hour billed.

4. Document Instruments Immediately

Record the standardized tools administered during the session to avoid omissions later.

5. Coordinate With Billing Staff

Ensure billing teams understand that 96113 is an add-on to 96112 and confirm unit accuracy before claim submission.

6. Review Claims Before Submission

Double-check diagnosis codes, authorization numbers, and time documentation to reduce rejection risk.

For a deeper look at how outsourcing can improve efficiency and reduce denials, explore our guide on Benefits of Hiring a Medical Billing Company.

Boost Revenue with Summit RCM’s Virtual Medical Assistants

CPT 96113 ensures providers are properly reimbursed for extended developmental testing, but accurate billing depends on precise time documentation, correct code pairing with 96112, medical necessity, and payer compliance. Even minor errors can lead to denials, delays, or lost revenue.

Summit RCM’s Virtual Medical Assistant services help practices manage authorizations, verify benefits, ensure accurate CPT coding, track documentation requirements, and reduce claim denials. Our experienced team supports your billing process so you can focus on delivering quality developmental care.