Billing code 96112: Developmental testingMedicare rate & RVUs in Guam
Report 96112 for physician- or qualified health care professional-led developmental testing with interpretation and a report, covering the initial hour of service.
Medicare pays $128.09 for 96112 in the office in Guam (Hawaii, Guam). Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 96112 covers
A physician or other qualified health care professional uses standardized developmental measures and clinical observation to assess areas such as motor skills, language, cognition, social functioning, memory, or executive function. The service is commonly performed in a pediatric, developmental, psychology, or rehabilitation setting when a child’s development needs a more complete evaluation than a brief screening can provide. The clinician interprets the results and prepares a report.
Report 96112 for the initial hour of qualifying developmental testing. Documentation should identify the assessment performed, the developmental domains evaluated, the clinician’s work, and the interpretation and report. When additional qualifying testing time is supported, report it with 96113, the add-on code for additional time. Medicare physician fee schedule valuation is available by setting; the submitted service and setting determine the applicable schedule amount.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
96112 in Hawaii, Guam
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam | $128.09 | $107.20 |
How the 96112 rate is calculated
Each of 96112’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 96112
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 2.56Practice expense 1.05Malpractice 0.14
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 96112
96112 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.
Place of service · 96112
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
Non-facility (office) rate · national
$125.25
The facility rate would be $106.88 (+$18.37). In a facility, the facility bills its own costs separately.
96112 compared with similar codes
Compare codes
96112 vs 96110 vs 96113 vs 96116 vs 96130: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 96110Developmental screen w/score
- Choose 96110 for developmental screening with a score. Choose 96112 when a physician or qualified health care professional performs a fuller developmental testing service with interpretation and a report.
- 96113Developmental testing
- 96112 represents the initial hour of developmental testing. 96113 is used for additional qualifying time and is reported as an add-on.
- 96116Neurobehavioral exam
- 96116 is for a neurobehavioral status examination. 96112 is for developmental testing focused on developmental domains assessed with appropriate measures.
- 96130Psychological evaluation
- 96130 covers psychological test evaluation. Use 96112 when the service is developmental testing, rather than psychological test evaluation.
96112 billing questions
How does 96112 differ from 96110?
96112 represents a more complete developmental testing service with interpretation and a report. 96110 is used for a developmental screening with a score, rather than this full testing service.
When is 96113 reported with 96112?
96113 is the add-on code for additional developmental testing time beyond the initial hour represented by 96112. The record should support the additional time and the work performed.
Can administration and interpretation be billed separately?
96112 encompasses the developmental testing service, including interpretation and reporting for the initial hour. Do not split those elements into separate services under this code.
What documentation supports 96112?
Document the standardized assessment, domains evaluated, time supporting the service, findings, interpretation, and resulting report. The record should show a developmental evaluation rather than only a brief screening.
Is 96112 the same as a neurobehavioral status examination?
No. 96112 is developmental testing using assessment measures and interpretation; 96116 addresses a neurobehavioral status examination, a different type of clinical evaluation.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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