Posted Oct. 30, 2020
In 1967, Congress introduced the Medicaid benefit for children and adolescents, known as Early and Periodic Screening, Diagnostic and Treatment (EPSDT). The goal of this benefit is to help ensure children and adolescents under the age of 21, who are enrolled in Medicaid, receive age-appropriate screenings, preventive services and treatments that are medically necessary to avert or diagnose, and treat any health problems as early as possible.1
Providers may want to keep the following points – EPSDT – in mind when providing care to children under 21 years of age.
Early: Assess each child’s health early in the life so any potential diseases and disabilities can be identified early, which may prompt treatment and prevent adverse health outcomes.
Periodic: Assess each child’s health at regular intervals to monitor healthy development.
- Providers may want to remind parents to have checkups in accordance with the Pediatric Preventive Care Guidelines.
- Provide Bright Futures educational handouts which are available in English and Spanish. Bright Futures is a national health promotion and prevention initiative, led by the American Academy of Pediatrics (AAP). It assists in providing education and anticipatory guidance for patients and families.2
Screening: Provide physical, vision, hearing, dental and developmental screenings to detect potential diseases and disabilities.3
- Provide comprehensive health and developmental history
- Provide comprehensive unclothed physical exam
- Provide recommended age appropriate immunizations
- Perform laboratory tests including lead screening
Diagnostic: Perform diagnostic tests to follow up when a health issue is identified
- Provide necessary referrals for follow-up care to ensure the child receives a complete diagnostic evaluation
Treatment: Control, correct or lessen health problems
- Help parents arrange care coordination for chronic conditions
- Be sure to code correctly for all medically necessary treatments
1Medicaid.gov, Early and Periodic Screening, Diagnostic, and Treatment, https://www.medicaid.gov/medicaid/benefits/early-and-periodic-screening-diagnostic-and-treatment/index.html
2Bright Futures, Practical Tips for Implementing Bright Futures in Clinical Practice, April 2019, https://brightfutures.aap.org/Bright%20Futures%20Documents/BF_Tips_ClinPractice_Tipsheet.pdf
3Medicaid.gov, Coverage in the Medicaid Benefit for Children and Adolescents, June 2014, https://www.medicaid.gov/sites/default/files/2019-12/epsdt_coverage_guide.pdf
The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. References to third party sources or organizations are not a representation, warranty or endorsement of such organizations. Any questions regarding those organizations should be addressed to them directly. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.