Pa. Issues Revised EPDST Program Periodicity Schedule for Children Enrolled in Medicaid

Last Updated: Aug 20, 2017

Pennsylvania's Department of Human Services (DHS) has issued a revised Early and Periodic Screening, Diagnosis, and Treatment (EPDST) Program Periodicity Schedule and Coding Matrix. The EPSDT benefit provides comprehensive and preventive health care services for children under age 21 who are enrolled in Medicaid, known as Medical Assistance (MA) in Pennsylvania.

The revised schedule and coding matrix took effect on Aug. 7, 2017 for clinicians enrolled in the MA program who provide EPSDT screens for MA beneficiaries in the Fee-For-Service and managed care delivery systems. DHS says that the schedule reflects recommendations from the American Academy of Pediatrics, American Dental Association, and American Academy of Pediatric Dentistry.

New Diagnosis Codes

The schedule also includes the addition of certain diagnosis codes to be used when submitting claims for EPSDT screens. The following additional ICD-10 diagnosis codes should be used for EPDST claims submitted for dates of service on or after Aug. 7, 2017, for MA beneficiaries aged 15 to 21 years of age:

  • Z00.00 (Encounter for general adult medical examination without abnormal findings)
  • Z00.01 (Encounter for general adult medical examination with abnormal findings)

Medical Assistance Bulletin 99-15-11 includes other ICD-10 diagnosis codes using for billing EPSDT screens. For a complete listing of referral codes, modifier, and diagnosis codes for the EPSDT program, get the billing guide here.

Other Notable Changes to the EPDST Program Periodicity Schedule

Other changes to the schedule include the following:

  • Newborn bilirubin concentration screening was added for the newborn inpatient visit.
  • Maternal depression screening was added for 1, 2, 4, and 6 month visits.
  • Adolescent depression screening was changed to begin at age 12.
  • Hearing screening was added to the newborn inpatient visit. If the hearing screening is not performed during this visit, it should be performed at the 1 month or 2-3 month visits.
  • Hearing screening was updated to occur once during the 11-14, 15-17, and 18-20 year visits.
  • HIV screening was updated to occur once between the 15 and 18 year visits.
  • Dyslipidemia screening was added to occur once between the 17 and 20 year visits.

For more details on the revisions as well as the complete schedule and coding matrix, access the DHS Medical Assistance Bulletin # 99-17-10 here.

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