Billing for Pediatric Therapy and ADOS Testing – There is so much diagnostic and standardized testing that goes into pediatric therapy. It requires a lot of documentation and time that is integral to creating a successful care plan for a patient. A common question that arises from clinic owners and providers of pediatric therapy is about ADOS (Autism Diagnostic Observation Schedule) testing and whether speech therapists can be paid for the screening and documentation around it.
Please note that this article is focusing on ADOS testing if you feel you or a speech therapist employed by you is capable of doing the test and making that diagnosis. This article is not insisting that ADOS testing is appropriate to be done by every office or every situation. ASHA’s official stance is below.
Speech-language pathologists who acquire and maintain the necessary knowledge and skills can diagnose ASD, typically as part of a diagnostic team or in other multidisciplinary collaborations, and the process of diagnosis should include appropriate referrals to rule out other conditions and facilitate access to comprehensive services.
There is no specific procedure code for ADOS testing. Instead, ADOS testing falls under two developmental testing codes.
96112: Developmental test administration (including assessment of fine and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified health care professional, with interpretation and report; first hour
96113: Each additional 30 minutes, should your testing exceed 1 hour
These codes cover both the actual test administration andthe reporting and interpretation that follows the test. You’ll want to be sure that you track your time spent both with the patient and working on the report afterward as they are both reimbursable.
Before billing these services you’ll want to ensure they are included in your fee schedule with any insurances you are in network with. Please note that these codes are not covered under the pediatric therapy fee schedule for Florida Medicaid and Florida Medicaid may require any diagnosis to be PCP-driven.