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Coding for EPSDT Visits |
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The Early and Periodic Diagnosis, Screening and Treatment (EPSDT) program is a comprehensive, preventive well-child screening service provided to Medicaid-eligible children from birth to age 21. The screening package includes a comprehensive health and developmental history with an assessment of physical and mental development, an unclothed physical exam and appropriate immunizations according to age and health history. EPSDT exams also include health education with anticipatory guidance as well as vision, hearing and dental screenings. Immunization administration, topical fluoride varnish, laboratory tests, blood level assessments, age-limited screenings and elective tests are covered separately utilizing the appropriate CPT codes. The service should be billed using diagnosis code V20.2 when no medical problems are identified. Medicaid policy does not allow providers to bill an EPSDT screening on the same day as a sick visit. If the child is due for an immunization and illness precludes the immunization, the reason for the delay should be documented and an appointment should be given for the patient to return at a later date. |
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