State & FederalMedicaidOctober 31, 2019

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

Beginning January 1, 2024, Empire became Anthem. This article, published under the former brand, now applies to Anthem.

Category: Medicaid

(Policy 06-0149, effective 02/01/20)

 

Currently, Empire BlueCross BlueShield HealthPlus 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, 2020, the following EPSDT component services will be separately reimbursable from the preventive medicine E&M visit:

  • 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.empireblue.com/nymedicaiddoc.

 

NYE-NU-0151-19 September 2019

 

PUBLICATIONS: November 2019 Empire Provider News