What is the EPSDT indicator?

What is the EPSDT indicator?

Early and Periodic Screening, Diagnostic and Treatment (EPSDT) is a Medi-Cal benefit for individuals younger than 21 years of age who have full-scope Medi-Cal eligibility. This benefit allows for periodic screenings to determine health care needs. EPSDT services include all services covered by Medi-Cal.

What is the CMS 416 report?

Purpose — The annual EPSDT report (form CMS-416) provides basic information on participation in the Medicaid child health program.

What is EPSDT on CMS 1500?

All providers billing for complete Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) screens must bill using the CMS-1500 Claim Form or electronically using the 837P format.

Which of the following are required components of EPSDT?

EPSDT is made up of the following screening, diagnostic, and treatment services:

• Screening Services.
• Vision Services. At a minimum, diagnosis and treatment for defects in vision, including eyeglasses.
• Dental Services.
• Hearing Services.
• Other Necessary Health Care Services.
• Diagnostic Services.
• Treatment.

How do you code a well child visit?

For established patients making a well baby/well child care visits: • For infants under age 1, use CPT code 99391. For children ages 1 to 4 (early childhood), use CPT code 99392. For children ages 5 to 11 (late childhood), use CPT code 99393.

What is EP modifier used for?

Modifier EP indicates routine Healthy Kids/EPSDT screening. Modifiers may be appended to HCPCS/CPT codes only if the clinical circumstances justify the use of the modifier. A modifier should not be appended to a HCPCS/CPT code solely to bypass NCCI edits if the clinical circumstances do not justify its use.

How do I bill Epsdt?

All EPSDT screening services must be reported with the age-appropriate evaluation and management code along with the EP modifier. The EP modifier must follow the evaluation and management code in the first line of Block 24D on the claim form. Use CPT Modifier plus CPT code when applicable.

What goes in Box 24h on HCFA 1500?

Box 24h is used to identify services that may be covered under specific state plans. If there is a requirement to use a specific reason code, then you would enter that code in the EPDST field on the session instead of entering a Y or N.

What is the CPT code for well child exam?

For new patients making a well baby/well child care visit: • For infants under age 1, use CPT code 99381. For children ages 1 to 4 (early childhood), use CPT code 99382.

What is the ICD 10 code for well child exam?

Z00.129
Well-child examinations 111 for a newborn 8 to 28 days old. For children 29 days old and older, use one of two codes: Z00. 121, Encounter for routine child health examination with abnormal findings, or Z00. 129, Encounter for routine child health examination without abnormal findings.

How do you code a physical?

If you perform a comprehensive physical, choose a procedure code from the Preventive Medicine codes CPT 99381-99387 for a new patient, or CPT 99391-99397 for an established patient, and select the code based on the patient’s age.

What is U2 modifier?

“If procedure is done as a referral from a hospital emergency department or urgent care facility or as an emergent procedure, enter appropriate CPT code with modifier U2.”

What does EPSDT stand for in screening?

Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) is a federally mandated preventive health care benefit. The purpose of this program is to periodically screen clients age 20 and younger to detect physical and behavioral health problems. If a problem or potential

What does EPSDT stand for in health?

Early and Periodic Screening, Diagnostic and Treatment (EPSDT) is the child health component of Medicaid. Federal statutes and regulations state that children under age 21 who are enrolled in Medicaid are entitled to EPSDT benefits and that States must cover a broad array of preventive and treatment services.

What is EPSDT indicator?

This rejection occurs when the 2300 Loop is missing the CRC segment (EPSDT indicator). The EPSDT (Early Periodic Screening, Diagnosis, and Treatment) referral information was expected but not found. Click Encounters > Track Claim Status. The Find Claim window opens. Look for and double-click on the encounter that needs correcting.

What does EPSDT stand for?

EPSDT: abbreviation for Early and Periodic Screening Diagnosis and Treatment .