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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.

The EPSDT special services component cover medically necessary items or services considered treatment and not covered by other Medicaid benefit.

Services

EPSDT special services may be preventive, diagnostic/treatment or rehabilitative. Examples of services covered through EPSDT special services include:

  • Additional pairs of eyeglasses after the Medicaid vision benefit has paid for the first two pair in a year.
  • Additional dental cleanings after the Medicaid dental benefit has paid for one cleaning.
  • Nitrous oxide used in dental treatment,
  • Nutritional products used as a supplement rather than as the child's total nutrition.

All EPSDT special services require prior authorization.

Some benefits not available through EPSDT special services include:

  • Respite care
  • Environmental services
  • Educational services
  • Vocational services
  • Cosmetic services
  • Convenience services
  • Experimental services
  • Over-the-counter items

Eligibility

EPSDT special services may be provided to only individuals younger than 21.

Services may be provided through the last day of the month in which the individual turns 21. For example, if someone receiving EPSDT special services turns 21 on March 16, that person may continue to receive EPSDT special services through March 31 (if still eligible for Medicaid.)

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

If your child is enrolled with a managed care organization, you may contact them at:

Provider Information 

How do I verify eligibility?

Once eligibility is confirmed, verify continued eligibility by contacting the automated voice response system at (800) 807-1301 or visiting KYHealth-Net System

Provider Contact information

Billing - DXC (800) 807-1232 or visit the website

Providers- Provider Services Call Center or (855) 824 5615

Provider enrollment/revalidation - Provider Enrollment or (877) 838-5085

KyHealth-net - email DXC 

Report fraud and abuse -  Fraud Hotline or  (502) 564-2348

Pharmacy Support Center - (800) 432-7005

Pharmacy Prior Authorization(800) 477-3071

MCO Information

Anthem - (800) 205-5870

Aetna Better Health of KY - (855) 300-5528

Humana Caresource - (855) 852-7005

Passport Health Plan- (800) 578-0775

WellCare of KY - (877) 389-9457