Z13.40 — Encounter for screening for unspecified developmental delays
ICD-10-CM
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Documentation Required
- Documentation that the child meets an eligible condition per state-defined criteria for developmental delay (medical/diagnostic documentation of developmental delay or high risk).
- Individual Family Service Plan (IFSP) for any child recognized as having a disability that interferes with learning from infancy to age 3; IFSP must include specific early intervention services the family and child will receive and a projection of their duration (per Education of the Handicapped Act Amendments requirement).
- When applicable, standardized developmental screening and testing results with scoring and documentation (e.g., use of standardized instruments as described by CPT/HCPCS such as 96110, 96112/96113, G0451) including interpretation and report.
- Clinical records supporting the medical necessity of component services (e.g., assessments, therapy plan, progress notes, rationale for PT/OT/speech therapy or other services tied to the eligible condition).
Key Coverage Criteria
- Early intervention programs (coordinated multidisciplinary care) for children from infancy to 3 years of age who have developmental delays or have a high potential for developmental delay.
- Children with biological conditions that may predispose to a developmental delay (eligible for early intervention services).
- Children at risk of developing developmental delays attributable to environmental factors (eligible for early intervention services).
- Coverage of component services of early intervention programs (such as speech therapy, physical therapy, occupational therapy, psychological counseling for families, nursing care, and physical or social stimulation) when the child presents with an eligible condition.
- Provision of services described in an Individual Family Service Plan (IFSP) for a child recognized as having a disability that interferes with learning from infancy to age 3 (IFSP defines specific early intervention services and projected duration).
- Neuropsychological testing (NPT) when provided to aid in the assessment of cognitive impairment due to medical or psychiatric conditions, when all of the following criteria are met: The number of hours or units requested for testing does not exceed the reasonable time necessary to address the clinical questions with the identified measures; and The testing techniques are validated for the proposed diagnostic question or treatment plan; and The testing techniques do not represent redundant measur [...]
3 Active Policies
CIGNA-0398 — Transvaginal Ultrasound, Non-Obstetrical - (0398)
AETNA-CPB-0158 — Neuropsychological and Psychological Testing
AETNA-CPB-0444 — Early Intervention Programs
Related Codes
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