The Early and Periodic Screening, Diagnostic, and Treatment (EPSDT
EPSDT
Early and Periodic Screening, Diagnostic and Treatment 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. Unlike private insurance, EPSDT is designed to address problems early, ameliorate conditions, and inter…
Medicaid
Medicaid in the United States is a federal and state program that helps with medical costs for some people with limited income and resources. Medicaid also offers benefits not normally covered by Medicare, including nursing home care and personal care services. The Health Insurance As…
What is early and Periodic Screening Diagnostic and treatment?
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. EPSDT is key to ensuring that children and adolescents receive appropriate preventive, dental, mental health, and developmental, and specialty services.
What is the difference between screening and diagnostic?
EPSDT benefit provides comprehensive screening, diagnostic, treatment and preventive health care services for individuals under the age of 21 who are enrolled in Medi-Cal. EPSDT services are intended to prevent or minimize developmental conditions and promoten — to the maximum extent practicable — healthy development. Based on the results of the EPSDT assessment …
What services does Medi-Cal cover for EPSDT?
May 06, 2022 · Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) The Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) service is Medicaid's comprehensive and preventive child health program for individuals under the age of 21. EPSDT has two purposes: to assure health care resources are available and accessible, and to help Medicaid recipients and …
Who can access EPSDT schedules?
Nov 02, 2021 · Early and Periodic Screening, Diagnostic, and Treatment Services. In accordance with the requirements in Section 1905 (r) of the Social Security Act and Title 42 Code of Federal Regulations (CFR) Section 441.50 et seq., the Department of Health Care Services (DHCS) is responsible for providing full-scope Medi-Cal beneficiaries under the age of 21 with a …
What type of program is EPSDT?
What does EPSDT stand for in medical billing?
What is Texas EPSDT?
What is the CMS 416 report?
What does Medicaid pay for?
When do we use EP modifier?
What is Texas Health Steps checkup?
Who currently qualifies for medical coverage under Texas Medicaid program?
What Is a Texas Health Steps provider?
What is EPSDT in Medicaid?
Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) The Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) service is Medicaid's comprehensive and preventive child health program for individuals under the age of 21.
What is EPSDT in healthcare?
EPSDT has two purposes: to assure health care resources are available and accessible, and to help Medicaid recipients and their caregivers use these resources.
Medi-Cal Coverage for EPSDT
Consistent with federal law and regulations for EPSDT, Medi-Cal covers all medically necessary services, including those to "correct or ameliorate" defects and physical and mental illness conditions.
Information for Medi-Cal Beneficiaries
Infants, children, and youth up to age 21 with full-scope Medi-Cal are able to receive EPSDT services.
Information for Medi-Cal Providers
Medi-Cal, health and mental health plans, and enrolled providers should inform Medi-Cal beneficiaries under age 21 about and how to access EPSDT benefits and services through written and oral information.
Helpful Resources and Documents
Medi-Cal Subscription Service (MCSS): A free service that provides the latest Medi-Cal news. Subscribers receive subject-specific emails for urgent announcements and other updates shortly after they post to the Medi-Cal website. To subscribe, please click on this website link.
Federal Approvals
SPA 15-034: Updates language regarding Early and Periodic, Screening, Diagnostic, and Treatment and preventive and wellness services.
What is EPSDT in Medicaid?
Early Periodic Screening, Diagnostic and Treatment Medicaid Services for Children. Early and Periodic Screening, Diagnosis and Treatment (EPSDT) is the federal law that says Medicaid must provide all medically necessary health care services to Medicaid-eligible children.
What is EPSDT in NC?
Early and Periodic Screening, Diagnosis and Treatment (EPSDT) is the federal law that says Medicaid must provide all medically necessary health care services to Medicaid-eligible children. Even if a service is not covered under the NC Medicaid State Plan, it can be covered for recipients under 21 years of age if the service is listed at 1905 (a) ...
What is a medically necessary condition?
Be medically necessary to correct or ameliorate a defect, physical or mental illness or a condition that is identified through a screening examination. Be listed in section 1905 (a) of the Social Security Act. Not be experimental/investigational, unsafe or considered ineffective.