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Early Periodic Screening, Diagnosis and Treatment Services (EPSDT) - Special Services Program

The 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 in which will be discussed below.

The EPSDT Special Services Program allows coverage for items or services which are medically necessary and which are not covered somewhere else in Medicaid. It is considered treatment.

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Attention Providers

Providers serving waiver members may request prior authorizations under their EPSDT PT-45 provider number for physical, occupational and speech therapies.,

(July 9, 2015) - Effective immediately and until further notice, providers serving waiver members with a prior authorization approved under a new physical, occupational or speech therapy provider type number may ask to replace it with a prior authorization under their EPSDT PT-45 number. Providers serving waiver members also may continue to submit new prior authorizations under their EPSDT PT-45 number until further notice.

For more information on the process, read the EPSDT Prior authorizations for PT OT ST provider notice (July 9, 2015)

Please contact HP at 1 (800) 807-1232 for assistance and if you have questions about submitting prior authorizations under the EPSDT PT-45 number to replace prior authorizations approved under the new provider type.

For questions about the EPSDT therapy services procedure codes and rates or other questions about EPSDT special services, contact Catherann Terry at (502) 564-9444, ext 2120.

Eligibility Information

EPSDT Special Services may only be provided to individuals under age 21.

Services may be provided through the last day of the month in which the individual turns 21. For example, if someone is receiving services through the EPSDT Special Services Program, and their 21st birthday is March 16, they may continue to receive services through EPSDT Special Services through March 31 (if they are still eligible for Medicaid.)

If your child in enrolled with a Managed Care Organization (MCO), you may contact them at:

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Covered and Non Covered Services

Services Covered

EPSDT Special Services may be preventive, diagnostic or treatment, or rehabilitative. Examples of services covered through the EPSDT Special Services include:

  • additional pairs of eyeglasses after the Medicaid Vision Program has paid for the first two pair in a year,
  • additional dental cleanings after the Medicaid Dental Program has paid for one cleaning,
  • nitrous oxide when used in dental treatment,
  • nutritional products when they are used as a supplement rather than as the child's total nutrition.

All EPSDT special services require prior authorization.

Noncovered Services

Some services that the EPSDT Special Services does not cover include:

  • respite care
  • environmental
  • educational
  • vocational
  • cosmetic
  • convenience
  • experimental
  • over the counter items

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FAQ's for Providers

How do providers enroll as EPSDT Providers?
For more information on enrollment, contact Provider Enrollment at (877) 838-5085 or visit the website.

MCO Information

How do I verify eligibility?
You may verify eligibility by one of the following methods:

  • by contacting the Automated Voice Response System at 800-807-1301,
  • by using the Web-based KYHealth-Net System

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Regulations, Letters, Forms, Billing Information and Publications


Provider Letters

View provider letters for this program.


Billing Information


Early Periodic Screening, Diagnosis and Treatment Brochure English - Version en Español


If you have questions

Regarding EPSDT Policy, contact:
Division of Program Quality and Outcomes
Disease and Case Management Branch
275 East Main Street
6 C-C
Frankfort, KY 40621
Phone: (502) 564-9444
CHFS DMS Webmaster

Regarding billing, contact HP at (800) 807-1232 or visit their website.

Regarding members, contact  (800) 635-2570

Regarding Provider Enrollment, contact Provider Enrollment at (877) 838-5085 or visit their website 

If your child has Medicaid and you need assistance with transportation, or for more information, contact:
(800) 635-2570.

For the hearing impaired, contact:
(800) 775-0296.


Last Updated 4/6/2017