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Early Periodic Screening, Diagnosis and Treatment Services (EPSDT)

Early and Periodic Screening, Diagnosis and Treatment (EPSDT) is a federally mandated Medicaid program for children. In Kentucky, it is divided into two components: EPSDT Screenings (see below) and EPSDT Special Services. Click below to view

EPSDT Screenings

The EPSDT Screening Program provides routine physicals or well-child check ups for Medicaid eligible children at certain specified ages. It is considered preventive care. Children are checked for medical problems early. Specific tests and treatments are recommended as children grow older.

The areas of health care that are checked include: preventive check-ups; growth and development assessments; vision; hearing; teeth; immunizations; and laboratory tests.

Children should receive health check-ups regularly or before the following ages: 1 month; 2 months; 4 months; 6 months; 9 months; 12 months; 15 months; 18 months; 24 months; 30 months; 3 years; 4 years; 5 years; 6 years; 8 years; and once a year for ages 6-20.

For more information, refer to the American Academy of Pediatrics Periodicity Schedule.

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

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Eligibility Information

Any Medicaid eligible child is eligible for EPSDT screenings. Additionally, any Medicaid eligible child may receive EPSDT Special Services as long as the services are medically necessary and not covered in another Medicaid program area.

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.)

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Information 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?
Once eligibility has been obtained, you may verify continued 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 and Billing Information
 

Regulations

Provider Letters

View Provider Letters for this program.

Forms

  • Map-005 - EPSDT Dental Evaluation Form (effective March 2008)
  • Map 9 - Prior Authorization for Health Services (July 2010) and Instructions
  • MAP -650 - EPSDT Home Health Fax Form

Billing Information
Provider Billing Manuals

Publications
Early Periodic Screening, Diagnosis and Treatment Brochure:

 

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
Email:
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 8/26/2014
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