Update: CDE Billing and Authorization Requirements
Date: 11/17/25
Sunshine Health would like to clarify billing and authorization requirements for Comprehensive Diagnostic Evaluations (CDEs).
CPT codes 96112 and 96113 do not require prior authorization for reimbursement. These codes may be billed as appropriate for developmental testing and evaluation services. There are no age limits for completing a CDE, and providers may perform and bill these services for any child when clinically indicated.
In addition, CPT codes 96160 and 96161 will no longer require prior authorization beginning January 30, 2026. This change is designed to reduce administrative steps and support timely access to care.
If you have questions or need help, please reach out to your Provider Engagement Account Manager (PEAM). To find your assigned PEAM, use the Find Your Account Manager tool. You can also call Provider Services at 1-844-477-8313.
Behavior Analysis (BA) Resources
- Sunshine Health Behavior Analysis (BA) Quick Reference Guide (QRG)
- Sunshine Health Behavior Analysis (BA) Frequently Asked Questions (FAQ)
- Behavior Analysis (BA) Services: CDE Documentation Requirements
- Behavior Analysis Peer-to-Peer Request Form
- Behavior Analysis (BA) Provider News
Questions?
Sunshine Health has a wealth of resources available to help answer your questions and address your concerns:
- Provider Support: Finding the Right Contact
- Provider Services: Call 1-844-477-8313
- Secure Provider Portal: Visit the Secure Provider Portal to check member eligibility, submit claims and more.
- Provider Engagement: Use the Find Your Account Manager tool to find the Provider Engagement Account Manager (PEAM) supporting your specialty and region.
- Claim Concerns: Resolve outstanding claims using the Claim Concerns form.
- Provider News: Bookmark Provider News to keep up with the latest updates.
- Provider Newsflash: Subscribe to our e-newsletter to get regular updates.
- Provider Resources: Visit Manuals, Forms and Resources to find provider manuals, important forms, scheduling standards and other resources.
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