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Submitting claims with "EPSDT" as the procedure code
"EPSDT" cannot be used as a procedure code for an EPSDT screening. Claims submitted with this code will be denied by Select Health. Providers must use appropriate CPT codes in order for claims to be paid.
Billing an EPSDT screening and an office visit on the same date of service
If an EPSDT screening and an office visit are billed on the same date of service, the EPSDT screening will be paid and the office visit will be denied. In the case that the child is sick and receives treatment or referral in addition to the EPSDT screens, be sure to bill for all services using a 25 modifier on the EPSDT CPT code to ensure accurate payment.
Using standard office visit procedure codes for EPSDT screenings
When EPSDT screens are billed using codes other than the preventive visit codes 99381-99385 and 99391- 99395, the claim is not recognized as an EPSDT visit. Members are not recorded in our system as completing an EPSDT visit and therefore do not receive their $10 gift card incentive.
Billing labs with an EPSDT screening
Laboratory tests are not a part of the screening package and may be billed and reimbursed as additional claim lines.
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