Epsdt personal provider form 2025

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If the first 5 or more components of an HCY/EPSDT screen are completed, you may bill using the age appropriate CPT code, EP modifier (along with modifier 52 to identify a partial screen was performed), and appropriate ICD-10 code to count toward your Participation Rate.
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.
EPSDT is made up of the following screening, diagnostic, and treatment services: Screening Services. Vision Hearing Services. Dental Services. Lead Screening. Immunizations/Vaccines for Children (VFC) Program. Other Necessary Health Care Services. Diagnostic Services. Treatment.
14 defines medical necessity for EPSDT services as follows: The state requires that Medicaid covers medically necessary services identified in a childs EPSDT screening whether or not such services are covered in the State Plan.
In addition to indicating an appropriate covered procedure code, providers submitting claims for members enrolled in Family Planning Only Services are required to identify the service as family planning-related by associating the procedure with modifier FP (Service provided as part of Family Planning program) or the
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