Early and Periodic Screening, Diagnostic and Treatment provides comprehensive and preventive health care services to Medicaid-eligible children under age 21. These services are federally mandated and intended to address children’s physical, mental and developmental health.
Well-child visits are the core of EPSDT. The goal is to discover and treat childhood health conditions before they become serious or disabling.
EPSDT services are defined as:
- Early – Assessing health care early in life so that potential disease and disabilities can be prevented or detected in their preliminary stages, when they are most effectively treated.
- Periodic – Assessing a child’s health at regular recommended intervals in the child’s life to assure continued healthy development.
- Screening – The use of tests and procedures to determine if children being examined have conditions warranting closer medical or dental attention.
- Diagnostic – The determination of the nature or cause of conditions identified by the screening.
- Treatment – The provision of services needed to control, correct or lessen health problems.
Requirements and Resources
All primary care providers who treat Medicaid members under the age of 21 are required to provide comprehensive health care, EPSDT screenings and preventive services in compliance with federal and state regulations and per the Bright Futures/American Academy of Pediatrics periodicity schedule.
For help with navigating program requirements and links to additional resources, see our EPSDT clinical practice and billing guideline.
The material presented here is for informational and educational purposes only, is not intended to be medical advice or a definitive source for coding claims and is not a substitute for the independent medical judgment of a physician or other health care provider. Health care providers are encouraged to exercise their own independent medical judgment based upon their evaluation of their patients’ conditions and all available information, and to submit claims using the most appropriate codes based upon the medical record documentation and coding guidelines and reference materials. References to other third party sources or organizations are not a representation, warranty or endorsement of such organization. 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.