MedicaidCoverageMedium impact
Developmental Screening in the First Three Years of Life (DEV)
Aetna Better Health of Virginia·VA · Pediatrics, Family Medicine, General Practice·Provider Notification
We identified it
Aug 13, 2026
Summary
Aetna Better Health of Virginia has issued a new HEDIS quality measure policy requiring developmental screening for children ages 1-3 using standardized tools at specific ages (9, 18, and 30 months), with autism-specific screening at 18 and 24 months. Billing teams must ensure CPT 96110 is captured when providers perform these screenings using approved standardized instruments to meet this quality metric for measurement year 2025.
Action Required
Effective immediately: (1) Providers and front desk staff must ensure developmental screening encounters for children ages 1-3 years are documented with CPT 96110 when a standardized screening tool is used (ASQ-3, PEDS, PEDS-DM, SWYC, BDI-ST, BINS, Brigance Screens-II, CDI, or Infant Developmental Inventory). (2) Billing team must verify claims include CPT 96110 with appropriate age-based diagnosis codes for children with documented developmental, behavioral, or social delay screening. (3) Providers should note that M-CHAT-R/F is autism-specific and does not meet Virginia developmental screening requirements but should be used for autism screening specifically. (4) Update encounter templates and reminders to prompt providers to use approved standardized screening tools during well-child visits. (5) Track these screenings for HEDIS reporting to Aetna Better Health of Virginia to demonstrate compliance with quality metrics. Failure to document and bill appropriately may result in missed quality measure performance and potential contract implications.