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Early Periodic Screening, Diagnosis and Treatment Services (EPSDT) - Special Services Program

Image Gently Campaign

The Kentucky Department of Medicaid Services (DMS) wants to encourage our medical community to recognize the importance of radiation safety in pediatric imaging. The Image Gently Campaign is an initiative of the Alliance for Radiation Safety in Pediatric Imaging.

Click the Attention Providers Image Gently poster for more information about this Campaign. You may also visit the Image Gently Web page for more information.

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.

Eligibility Information

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

Services Covered

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.

Noncovered Services

Some services that the EPSDT Special Services does not cover include:

  • respite care
  • environmental
  • educational
  • vocational
  • cosmetic
  • convenience
  • experimental
  • 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).

 

Regulations, Letters, Forms, Billing Information and Publications
 

Regulations

Provider Letters

To view older provider letters, click here.

Forms

Billing Information

Publications

 

If you have questions
 

Regarding EPSDT Special Services Policy, contact:
Division of Provider Operations
Specialty Services Branch
275 East Main Street
6W-D
Frankfort, KY 40621
Phone: (502) 564-9444
Email:
CHFS DMS Webmaster

Regarding billing, contact EDS at (800) 807-1232 or visit their website

Regarding members, contact Member Services at (800) 635-2570

Regarding Provider Enrollment , contact Provider Enrollment at (877) 838-5085 or visit their website

If your child has Medicaid and you need assistance with transportation, or for more information, contact:
(800) 635-2570.

For the hearing impaired, contact:
(800) 775-0296.

 

Last Updated 1/17/2014
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