Early Periodic Screening, Diagnosis and Treatment Services (EPSDT) - Special Services Program
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|| EPSDT Special Services Program
The Early and Periodic Screening, Diagnosis and Treatment (EPSDT) is federally mandated Medicaid program for children. In Kentucky, it is divided into two components: EPSDT Screenings and EPSDT Special Services in which will be discussed below.
The EPSDT Special Services Program allows coverage for items or services which are medically necessary and which are not covered somewhere else in Medicaid. It is considered treatment.
EPSDT Special Services may only be provided to individuals under age 21.
Services may be provided through the last day of the month in which the individual turns 21. For example, if someone is receiving services through the EPSDT Special Services Program, and their 21st birthday is March 16, they may continue to receive services through EPSDT Special Services through March 31 (if they are still eligible for Medicaid.)
||Covered and Non Covered Services
EPSDT Special Services may be preventive, diagnostic or treatment, or rehabilitative. Examples of services covered through the EPSDT Special Services include:
- additional pairs of eyeglasses after the Medicaid Vision Program has paid for the first two pair in a year,
- additional dental cleanings after the Medicaid Dental Program has paid for one cleaning,
- nitrous oxide when used in dental treatment,
- nutritional products when they are used as a supplement rather than as the child's total nutrition,
- speech therapy, occupational therapy or physical therapy when the therapy does not meet the criteria for the Medicaid Home Health Program, and substance abuse treatment.
All EPSDT special services require prior authorization.
Note: Children who pay the KCHIP III Premium are not eligible for EPSDT Special Services or non-emergency transportation.
Some services that the EPSDT Special Services does not cover include:
- respite care
- over the counter items
||FAQ's for Providers
Who may provide for EPSDT Special Services?
EPSDT Special Services may only be provided by individuals or agencies that may enroll in the regular Medicaid program. EPSDT Special Services providers must have a separate provider number.
How do I verify eligibility?
You may verify eligibility by one of the following methods:
- by contacting the Automated Voice Response System at (800) 807-1301,
- by using the Web-based KYHealth-Net System
- by purchasing and using a swipe card reader
How do providers enroll as EPSDT Special Services Providers?
If a provider is already enrolled in the Medicaid program and wants to also become an EPSDT Special Services provider, they must complete the one page EPSDT Special Services Short Form (MAP-814). If a provider is not currently enrolled in the Medicaid program and does not wish to become a regular Medicaid provider but does want to be an EPSDT Special Services provider (and could enroll as a regular Medicaid provider if they chose to do so), they must complete the Non-Credentialed Provider Application (Includes Map 811 and MAP 811 Addendum E).
For more information on enrollment, contact Provider Enrollment at (877) 838-5085 or visit the Web site.
Can individual practitioners such as occupational therapists and physical therapists enroll as EPSDT Special Services Providers?
No, individual practitioners such as occupational therapists, physical therapists, speech pathologists, psychologists, etc. may not enroll as EPSDT Special Services providers, since they may not enroll in the regular Medicaid program (except as QMB Only providers).