MedicaidDocumentationHigh impact
Developmental Screening in the First Three Years of Life (DEV)
Aetna Better Health of Virginia·VA · Pediatrics·Provider Notification
We identified it
Oct 3, 2026
Summary
Aetna Better Health of Virginia has issued a new HEDIS Measurement Year 2025 policy requiring developmental screening for children ages 1-3 using standardized tools at specific intervals (9, 18, and 30 months), with autism screening required at 18 and 24 months. Billing teams must ensure CPT 96110 is properly captured when providers perform these screenings using approved standardized instruments to meet quality measure requirements.
Action Required
Immediately: (1) Billing team must verify CPT 96110 is properly configured in billing software for pediatric well-child visits. (2) Ensure encounter forms and templates prompt providers to document which standardized screening tool was used (ASQ-3, PEDS, PEDS-DM, SWYC, BDI-ST, BINS, Brigance Screens-II, CDI, or Infant Developmental Inventory for developmental screening; M-CHAT-R/F for autism screening). (3) Update internal guidelines to clarify that M-CHAT-R/F alone does not satisfy Virginia's developmental screening requirement—it must be used IN ADDITION to a standardized developmental screening tool. (4) Coordinate with pediatric providers to confirm screening completion at recommended ages (9, 18, 30 months for development; 18, 24 months for autism). (5) Monitor claim submissions to ensure appropriate documentation is attached; claims lacking documented use of a recognized standardized tool may be denied for failing HEDIS measure requirements.