Reimbursement Policy Update: Early and Periodic Screening, Diagnosis and Treatment (EPSDT)

Category: Medicaid

 

(Policy 06-0149, effective 02/01/19)

Currently, Anthem Blue Cross and Blue Shield includes Early and Periodic Screening, Diagnosis and Treatment (EPSDT) component services in the reimbursement of preventive medicine evaluation and management (E&M) visits unless they are appended with Modifier 25 to indicate a significant, separately identifiable E&M service by the same physician on the same date of service.

 

However, effective February 1, 2019, the following EPSDT component services will be separately reimbursable from preventive medicine E&M visits:

• Hearing screening with or without the use of an audiometer or other electronic device
• Vision screening

 

For additional information, please review the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) reimbursement policy at www.anthem.com/inmedicaiddoc.