Applies to:

Medicaid, MIChild, Healthy Michigan Plan

Definition:

Use these codes when reporting early and periodic screening, diagnosis and treatment (EPSDT) "Normal Newborn" or "Well Child" exams of Medicaid patients. 

Go to the www.mich.gov website for the EPSDT Guidelines.

Another resource is the American Academy of Pediatrics' "Bright Futures" website.  Scroll down their web page to find the AAP Periodicity Schedule. 

Go to the Bright Futures website.

EPSDT billing

New patient visits

99460: History & physical of inpatient "Normal Newborn"

99463: History & physical of newborn for same day discharge

99381: Initial evaluation, under age of 1 year

99382: Initial evaluation, age 1-4 years

99383: Initial evaluation, age 5-11 years

99384: Initial evaluation, age 12-17 years

99385: Initial evaluation, age 18-21

Established patient visits

99391: Reevaluation, under age of 1 year

99392: Reevaluation, age 1-4 years

99393: Reevaluation, age 5-11 years

99394: Reevaluation, age 12-17 years

99395: Reevaluation, age 18-21 years

EPSDT-required services that may be billed separately

When performed according to the periodicity table. For complete descriptions, refer to the Physician's Current Procedural Terminology code book.

85014: Hematocrit

85018: Hemoglobin

81002: Urine testing with standardized reagent dipstick for sugar & albumin

Vaccines & immunizations

See billing codes

86580 or 86585: Tuberculin testing (TB)

90460, 90471, 90473: One vaccine

90472, 90474: Subsequent vaccines; must bill administration code and immunization code, even if immunization serum was free.

96110: Developmental testing, limited (e.g., developmental screening test II, early language milestone screen) with interpretation and report

96111: Developmental testing, extended (includes assessment of motor, language, social, adaptive and/or cognitive functioning by standardized developmental instruments) with interpretation and report