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​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 (see 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.

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.

All EPSDT special services require prior authorization.

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

  • respite care
  • environmental
  • educational
  • vocational
  • cosmetic
  • convenience
  • experimental
  • over the counter items

Eligibility

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 you questions, please contact Member Services at (800) 635-2570

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

Provider Information 

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

Provider Contact information

  •  For billing questions, contact DXC at (800) 807-1232 or visit the website
  • For provider questions, contact the Provider Services Call Center at  (855) 824 5615
  • For provider enrollment or revalidation questions, contact Provider Enrollment at  (877) 838-5085
  • For KyHealth-net assistance, email DXC 
  • To report fraud and abuse, contact Fraud Hotline at (502) 564-2348
  • For pharmacy questions, contact Pharmacy Support Center at (800) 432-7005
  • For pharmacy prior authorization questions, contact Pharmacy Prior Authorization at (800) 477-3071

MCO Information

Providers serving waiver members may request prior authorizations under their EPSDT PT-45 provider number for physical, occupational and speech therapies.
(July 9, 2015) - Effective immediately and until further notice, providers serving waiver members with a prior authorization approved under a new physical, occupational or speech therapy provider type number may ask to replace it with a prior authorization under their EPSDT PT-45 number. Providers serving waiver members also may continue to submit new prior authorizations under their EPSDT PT-45 number until further notice.

For questions about the EPSDT therapy services procedure codes and rates or other questions about EPSDT special services, contact (502) 564-9444.