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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

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