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Early Periodic Screening, Diagnosis and Treatment Services (EPSDT)

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.

Early and Periodic Screening, Diagnosis and Treatment Program

Early and Periodic Screening, Diagnosis and Treatment (EPSDT) is a federally mandated Medicaid program for children. In Kentucky, it is divided into two components: EPSDT Screenings (in which is discussed below) and EPSDT Special Services.

EPSDT Screenings

The EPSDT Screening Program provides routine physicals or well-child check ups for Medicaid eligible children at certain specified ages. It is considered preventive care. Children are checked for medical problems early. Specific tests and treatments are recommended as children grow older.

The areas of health care that are checked include: preventive check-ups; growth and development assessments; vision; hearing; teeth; immunizations; and laboratory tests.

Children should receive health check-ups regularly or before the following ages: 1 month; 2 months; 4 months; 6 months; 9 months; 12 months; 15 months; 18 months; 24 months; 3 years; 4 years; 5 years; 6 years; 8 years; and once a year for ages 10-20.

Eligibility Information

Any Medicaid eligible child is eligible for EPSDT screenings. Additionally, any Medicaid eligible child may receive EPSDT Special Services as long as the services are medically necessary and not covered in another Medicaid program area. Children who are KCHIP III are not eligible for EPSDT Special Services or non-emergency transportation.

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.)

Information for Providers

Provider information for EPSDT Screenings:
EPSDT Screenings may be performed by physicians or ARNPs in either individual or group practices, physicians in primary care or rural health centers, physicians or nurses in the local health departments or EPSDT screening clinics. The EPSDT screening clinics must have separate provider number. Physicians, ARNPs, primary care centers, rural health centers and local health departments do not have to have a separate provider number to do EPSDT screenings.

How do I verify eligibility?
Once eligibility has been obtained, you may verify continued 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 Providers?
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 website.

 

Regulations, Letters, Forms and Billing Information
 

Regulations

Provider Letters

To view older provider letters, click here.

Forms

  • Map-005 - EPSDT Dental Evaluation Form (effective 03/08)
  • Map 9 - Prior Authorization for Health Services (07/10) and Instructions
  • MAP -650 - EPSDT Home Health Fax Form

Billing Information
Provider Billing Manuals

Publications
Early Periodic Screening, Diagnosis and Treatment Brochure:

 

If you have questions
 

Regarding EPSDT Policy, contact:
Division of Provider Operations
Specialty Services Branch
275 East Main Street
6 W-D
Frankfort, KY 40621
(502) 564-6890

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 

Contact us by email:
CHFS DMS Webmaster

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 3/18/2014
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