What is covered by EPSDT?
Known as EPSDT screening visits, the program defines and finances preventive well-child visits that include a comprehensive health and developmental history, an unclothed physical exam, immunizations, laboratory tests, and health education and guidance for parents and children.
What is EPSDT on CMS 1500?
An EPSDT screen is complete when codes from each service area required for that age, including the appropriate evaluation and management codes, are documented. Claims will be paid at the provider’s EPSDT rate only if the appropriate evaluation and management code and EP modifier are submitted.
What age is EPSDT for?
Infants, children, and youth up to age 21 with full-scope Medi-Cal are able to receive EPSDT services.
What is EPSDT dental program?
The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit provides comprehensive and preventive health care services for children under age 21 who are enrolled in Medicaid. Treatment: Control, correct or reduce health problems found.
What is the purpose of Epsdt?
Related Resources. The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit provides comprehensive and preventive health care services for children under age 21 who are enrolled in Medicaid.
What does Epsdt stand for in medical billing?
A. “EPSDT” stands for Early and Periodic Screening, Diagnostic and Treatment. The EPSDT benefit provides comprehensive and preventive health services for children under age 21 who are enrolled in Medicaid.
What is the purpose of EPSDT?
How many components are there in the EPSDT exam?
The screening services must include five components: a comprehensive health and developmental history (assessing physical and mental health, as well as substance use disorders), an unclothed physical examination, appropriate immunizations, laboratory tests, and health education (§1905(r) of the Social Security Act (the …
What do you need to know about EPSDT services?
EPSDT Services States are required to provide comprehensive services and furnish all Medicaid coverable, appropriate, and medically necessary services needed to correct and ameliorate health conditions, based on certain federal guidelines. EPSDT is made up of the following screening, diagnostic, and treatment services:
Do you need prior authorization for EPSDT screening?
For example, states may require prior authorization for a certain treatment service (though prior authorization cannot be required for EPSDT screening services) ( CMS 2014a ). States may also consider cost-effectiveness.
How many children are eligible for EPSDT each year?
EPSDT was introduced as a part of the Social Security Act Amendments of 1967. In fiscal year (FY) 2014, over 40 million children were eligible for EPSDT (CMS 2016). However, just under 60 percent of children who should have received at least one initial or periodic screening received one (CMS 2016).
What does medical necessity not file under EPSDT mean?
Medical Necessity documentation missing or incomplete: Medical necessity has not been demonstrated due to a lack of or incomplete documentation. Service not filed under EPSDT: EPSDT review requires that “EPSDT” be indicated on the prior authorization request.