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Early Periodic Screening, Diagnosis and Treatment Services (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.

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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.)

If your child in enrolled with a Managed Care Organization (MCO), you may contact them at:

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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.

All EPSDT special services require prior authorization.

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

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FAQ's for Providers

How do providers enroll as EPSDT Providers?
For more information on enrollment, contact Provider Enrollment at (877) 838-5085 or visit the website.

MCO Information

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

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Regulations, Letters, Forms, Billing Information and Publications
 

Regulations

Provider Letters

View provider letters for this program.

Forms

Billing Information

Publications

Early Periodic Screening, Diagnosis and Treatment Brochure English - Version en Español

 

If you have questions
 

Regarding EPSDT Policy, contact:
Division of Program Quality and Outcomes
Disease and Case Management Branch
275 East Main Street
6 C-C
Frankfort, KY 40621
Phone: (502) 564-9444
Email:
CHFS DMS Webmaster

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

Regarding members, contact  (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 8/26/2014
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