Skip to main content

What is EPSDT



What is EPSDT?

EPSDT stands for Early and Periodic screening, Diagnostic and Treatment program. Its is required in every state and designed to improve the health of low income children. By supporting and financing appropriate and necessary. It’s a Medical benefit for individuals under the age of 21 who have full-scope Medical eligibility. This benefit allows for periodic screenings to determine health care needs. Based upon the identified health care need, diagnostic and treatment services are provided.

Services offered by EPSDT

EPSDT services include all services covered by Medical. In addition to the regular Medical benefits, a beneficiary under the age of 21 may receive additionally medically necessary services. These additional services are known as EPSDT Supplemental Services and include: private duty nursing services from a Registered Nurse (RN) or a Licensed Vocational Nurse (LVN), Case Management, Paediatric Day Health Care, and Nutritional and Mental Health Evaluations and Services.

Dental

Vision

Hearing

Mental Health

EPSDT Billing Guide
NEW PATIENT


99460**
Normal Newborn Care (during admission)

99463**
Normal Newborn Care (same day discharge)

99381**
INITIAL SCREENING
Less than 1 year of age
99382**
INITIAL SCREENING
1-4 years of age
99383**
INITIAL SCREENING
5-11 years of age
99384**
INITIAL SCREENING
12-17 years of age
99385**
INITIAL SCREENING
18-20 years of age
ESTABLISHED PATIENT


99391**
PERIODIC SCREENING
Less than 1 year of age
99392**
PERIODIC SCREENING
1-4 years of age
99393**
PERIODIC SCREENING
5-11 years of age
99394**
PERIODIC SCREENING
12-17 years of age
99395**
PERIODIC SCREENING
18-20 years of age
SERVICES


96110**
Developmental Testing Screening
0-20 years of age
83655
Lead Testing Screening
0-20 years of age
99173
Vision Screening
3-20 years of age
92551
Hearing Screening (Audio)
3-20 years of age
92552
Hearing Screening (Pure tone-air only)
3-20 years of age
85013**
Anemia (Hematocrit spun)
9 & 12 months of age
85018**
Anemia (Hemoglobin)
9 & 12 months of age
80061
Dyslipidemia
18-20 years of age



Modifiers


EP
Complete Screen

52
Incomplete Screen

90
Outpatient Lab

U1
Autism







ICD-9 Diagnosis


Codes


V20.0
Health supervision of infant or Child
0-20 years of age
V20.1
Other healthy infant or child receiving care
0-20 years of age
V20.2
Routine infant or child health check
0-20 years of age
V70.0
Routine general medical examination at a health care facility
0-20 years of age
V70.3
Other medical examination for administrative purposes
0-20 years of age
V70.5
Health examination of defined subpopulations
0-20 years of age
V70.6
Health examination in population surveys
0-20 years of age
V70.8
Other specified general medical examinations
0-20 years of age
V70.9
Unspecified general medical examination
0-20 years of age

Comments

Post a Comment

Popular posts from this blog

What is QMB / MQMB stands for?

In Medical billing or Healthcare industry The term QMB stands for Qualified Medicare Beneficiary & MQMB stands for Medicare Qualified Medicare Beneficiary. The term "QMB" or "MQMB" on the form indicates the client is a Qualified Medicare  Beneficiary (QMB) or a Medicaid Qualified Medicare Beneficiary (MQMB). The Medicare Catastrophic Coverage Act of 1988 requires Medicare premiums, deductibles, and coinsurance payments to be paid for individuals who meet the following criteria:  Important: Clients limited to QMB are not eligible for THSteps or THSteps-CCP Medicaid benefits.  Note: Clients eligible for STAR+PLUS who have Medicare and Medicaid are MQMBs. Medicaid reimburses for the coinsurance and deductibles as well as Medicaid-only services for the MQMB client. QMBs do not receive Medicaid benefits other than Medicare deductible and coinsurance liabilities. MQMBs do qualify for Medicaid benefits not covered by Medicare in addition
7 comments
Read more

Mastering the 'Tell Me About Yourself' Interview Question: Best Tips and Examples

In a job interview, the "Tell me about yourself" question is often asked early on and is an opportunity to make a positive first impression. The key is to provide a comprehensive response that highlights your qualifications and aligns with the job you're applying for. Here's a structured approach to crafting the best answer: Start with a Brief Personal Introduction: Begin by mentioning your name and your current or most recent role, if applicable. For example, "I'm [Your Name], and I'm currently working as a Sr AR Specialist at XYZ Company." Provide a Summary of Your Professional Background: Offer a concise overview of your professional journey, emphasizing the experiences and skills most relevant to the position you're interviewing for. You can mention your years of experience, notable career achievements, and areas of expertise. Highlight Relevant Achievements: Share specific accomplishmen
Post a Comment
Read more

Rejection Procedure note qualifier is missing

  Need to check the Charges tab and double click on the Procedure Code line to open up the Charge Entry window. There is a Notes section on the right hand side. If there is a note typed, we need to select the type.   Need to select field and select the appropriate type of note you are sending.   Save the changes made   Check all the procedure if submitted many procedure.   Save the visit again and submit the claim.
Post a Comment
Read more