What is the CMS 416 report?

Purpose — The annual EPSDT report (form CMS-416) provides basic information on participation in the Medicaid child health program.

What is an EPSDT indicator?

The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit provides comprehensive and preventive health care services for children under age 21 who are enrolled in Medicaid.

What consequences will a state face for failure to provide EPSDT services to Medicaid recipients?

Where EPSDT Fails in Lead Screening. Exposure to lead can lead to serious health consequences ranging from anemia to behavioral and neurologic disorders. EPSDT requires that children enrolled in Medicaid be screened for lead in their blood at 12 months and 24 months of age.

What is covered under EPSDT?

Known as EPSDT screening visits, the program defines and finances preventive well-child visits that include a comprehensive health and developmental history, an unclothed physical exam, immunizations, laboratory tests, and health education and guidance for parents and children.

How do I bill Epsdt?

All EPSDT screening services must be reported with the age-appropriate evaluation and management code along with the EP modifier. The EP modifier must follow the evaluation and management code in the first line of Block 24D on the claim form. Use CPT Modifier plus CPT code when applicable.

Who qualifies EPSDT?

Medi-Cal gives health care to people with low income and limited ability to pay for health care. If you are under age 21 and have full-scope Medi-Cal, you get EPSDT. It gives you with a number of health care benefits.

Who is eligible for EPSDT?

Early and Periodic Screening, Diagnostic and Treatment (EPSDT) is the child health component of Medicaid. Federal statutes and regulations state that children under age 21 who are enrolled in Medicaid are entitled to EPSDT benefits and that States must cover a broad array of preventive and treatment services.

What is EP modifier?

Modifier EP indicates routine Healthy Kids/EPSDT screening. Modifiers may be appended to HCPCS/CPT codes only if the clinical circumstances justify the use of the modifier. A modifier should not be appended to a HCPCS/CPT code solely to bypass NCCI edits if the clinical circumstances do not justify its use.

How many times can 99392 be billed?

A single physician or other qualified health care professional should not report 99483 more than once every 180 days.

What is Epsdt California?

Early and Periodic Screening, Diagnostic, & Treatment (EPSDT) is a Medi-Cal benefit for individuals under the age of 21 who have full-scope Medi-Cal eligibility. This benefit allows for periodic screenings to determine health care needs. EPSDT services include all services covered by Medi-Cal.

How do I bill EPSDT?

What is the AG modifier used for?

AG Primary physician Surgical: Used to denote a primary surgeon. In the case of multiple primary surgeons, two or more surgeons can use modifier AG for the same patient on the same date of service if the procedures are performed independently and in different specialty areas.