Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.05-007 - Child Health Services EPSDT Update #57

Current through Register Vol. 49, No. 6, June, 2024
Section II
Child Health Services/Early
			 and Periodic Screening, Diagnosis, and Treatment
200.000
CHILD HEALTH SERVICES (EPSDT)
			 GENERAL H INFORMATION T
201.000
Arkansas Medicaid
			 Participation Requirements for Child Health Services (EPSDT) Providers Except
			 School-Based Child Health Services Providers
The Arkansas Division of IVIedical Services (DIVIS) recruits
				providers for medical, dental, visual, and hearing screenings and treatment
				services. All Child Health Services (EPSDT) providers are required to complete
				a provider application (DMS-652), a Medicaid contract (DMS-653) and a Request
				for Taxpayer Identification Number and Certification (W-9).
View or print a provider application (form DMS-652), a
				Medicaid contract (form DMS-653) and a Request for Taxpayer Identification
				Number and Certification (Form W-9).
The Arkansas Medicaid Program must approve the provider
				application and the Medicaid contract as a condition of participation in the
				Medicaid Program. Persons and entities that are excluded or debarred under any
				state or federal law, regulation or rule are not eligible to enroll, or to
				remain enrolled, as Medicaid providers.
Providers must consider the screening fee designated by the
				Arkansas Medical Assistance Program as payment in full and are prohibited by
				law from requesting or receiving additional payment from the recipient or his
				or her responsible relatives.
Any licensed physician, family practitioner, obstetrician,
				pediatrician, optometrist, etc., or any outpatient hospital, community or
				public health clinic, supervised by a licensed physician that is enrolled in
				the Arkansas Medical Assistance Program and offers the screening package as
				outlined in the recommended screening procedures, is eligible to participate in
				the Child Health Services (EPSDT) Program.
In addition, providers offering screening components, including
				vision, hearing and dental screens, may enroll as Child Health Services (EPSDT)
				providers. Such providers may include optometrists, licensed audiologists and
				others.
In addition to signing the Medicaid application and contract,
				an eligible Child Health Services (EPSDT) provider must sign an agreement to
				participate as a Child Health Services (EPSDT) screening provider.
View or print participatinq EPSDT provider
				aqreement.
If interested, please contact the Central Child
				Health Services (EPSDT) Office.
View or print the Central
				Child Health Services (EPSDT) contact information
.
Payment
				for screens performed by providers who have not signed an agreement will be
				denied.
When Child Health Services (EPSDT) medical screenings, medical
				screening components or immunizations are not performed by a physician
				provider, the screening provider must have a written agreement with a physician
				who assumes the responsibility for the provision of Child Health Services
				(EPSDT) screenings and immunizations and agrees:
A. To be available on a routine basis for
			 consultation to screening staff,
B.
			 To ensure that screening staff have appropriate training and adequate skills
			 for performing the procedures for which they are responsible and
C. To periodically review the staffs level of
			 performance in administering these procedures.
The physician does not have to be physically present in the
				clinic at all times during the hours of operation. However, the physician must
				assume responsibility for the clinic's operation. All screenings and
				immunizations must be performed by personnel meeting, at a minimum, registered
				nurse status.
202.000
Arkansas Medicaid
			 Participation Requirements for School-Based Child Health Services
			 Providers
School districts and education service cooperatives may provide
				all Child Health Services (CHS/EPSDT) screening services. A school district or
				cooperative may participate at one of two levels, as either a comprehensive
				screening provider who will provide all EPSDT screening components, or as a
				provider for vision and/or hearing screens.
Schools enrolling as comprehensive screening providers must
				meet the following criteria:
A. The
			 provider must complete a provider application (form DMS-652), a Medicaid
			 contract (form DMS-653) and a Request for Taxpayer Identification Number and
			 Certification (Form W-9).
View or print a provider
			 application (form DMS-652), a Medicaid contract (form DMS-653) and a Request
			 for Taxpayer Identification Number and Certification (Form
			 W-9).
B. The
			 provider application and Medicaid contract must be approved by the Arkansas
			 Medicaid Program.
C. The Arkansas
			 Medicaid Program must approve the provider application and the Medicaid
			 contract as a condition of participation in the Medicaid Program. Persons and
			 entities that are excluded or debarred under any state or federal law,
			 regulation or rule are not eligible to enroll, or to remain enrolled, as
			 Medicaid providers.
D. The provider
			 must sign an agreement to participate as a Child Health Services (CHS)
			 screening provider.
View or print participatinq EPSDT
			 provider aqreement.
E. The provider must be certified as a
			 comprehensive CHS/EPSDT provider by the superintendent of schools.
View or print Certification of Schools to
				Provide Comprehensive EPSDT Services form.
Schools or education service cooperatives enrolling as
				screeners for hearing and vision, hearing only or vision only must meet the
				following criteria:
A. The provider
			 must complete a provider application (form DMS-652), a Medicaid contract (form
			 DMS-653) and a Request for Taxpayer Identification Number and Certification
			 (Form W-9).
View or print a provider application (form
				DMS-652), a Medicaid contract (form DMS-653) and a Request for Taxpayer
				Identification Number and Certification (Form
				W-9).
B.
			 The provider application and Medicaid contract must be approved by the Arkansas
			 Medicaid Program.
C. The Arkansas
			 Medicaid Program must approve the provider application and the Medicaid
			 contract as a condition of participation in the Medicaid Program. Persons and
			 entities that are excluded or debarred under any state or federal law,
			 regulation or rule are not eligible to enroll, or to remain enrolled, as
			 Medicaid providers.
D. The provider
			 must sign an agreement to participate as a CHS screening provider per Section
			 201.000 of this manual.
View or print participatinq EPSDT provider
				aqreement.
E. The provider must employ a licensed
			 registered nurse who has completed training in vision and hearing conducted by
			 the Arkansas Department of Health, Office of Hearing, Speech, and Vision
			 Services. A copy of the nurse's current license and the certificate of
			 completion of vision and hearing screening training from the Arkansas
			 Department of Health must accompany the application.
NOTE: School districts or education service cooperatives
				employing a qualified speech pathologist may complete an agreement to
				participate as a screening provider, using the speech pathology Medicaid
				provider number. The qualified speech pathologist may perform hearing screens
				and be reimbursed under the Medicaid provider number for speech
				pathology.
In situations where speech pathology services are provided by a
				qualified speech pathologist, who is contracted with a school district or an
				education service cooperative, the individual qualified speech pathologist may
				complete the agreement to participate as a CHS screening provider and perform
				hearing screens under the individual Medicaid
				number.
212.000
Scope
The Child Health Services (CHS) Early and Periodic Screening,
				Diagnosis and Treatment (EPSDT) Program is a federally mandated child health
				component of Medicaid. It is designed to bring comprehensive health care to
				individuals eligible for medical assistance from birth to age 21. Even if the
				person eligible for medical assistance is a parent, he or she is eligible for
				Child Health Services (EPSDT) if under age 21. Physicians and other health
				professionals who provide Child Health Services (EPSDT) screening may diagnose
				and treat health problems discovered during the EPSDT screening or may refer
				the child to other appropriate sources for such care.
The following is a broad definition of the components of the
				Child Health Services EPSDT program.
Early
means as soon as possible in the
				child's life, or as soon as his or her family's eligibility for assistance has
				been established.
Periodic
means at intervals
				established for screening by medical, dental, visual and other health care
				experts. The types of screening procedures performed and their frequency will
				depend on the child's age and health history. In Arkansas, the medical periodic
				screening schedule has been established following the recommendations of the
				American Academy of Pediatrics.
Interperiodic
means providing
				medically necessary screenings between the recommended age ranges for medical,
				visual, hearing and dental screenings in order to determine the existence of
				suspected illnesses or conditions.
Partial means a medical screen consisting of one or more of the
				Child Health Services (EPSDT) medical screening components, but not all
				components.
Screening
is the use of quick, simple
				procedures to sort out apparently well persons from those who may have a
				disease or abnormality and to identify those in need of a more definitive
				examination.
Diagnosis
is the determination of the
				nature or cause of a disease or abnormality through the combined use of health
				history, physical, developmental and psychological examination, laboratory
				tests and X-rays.
Treatment
means physician, hearing,
				visual or dental services or any other type of medical care and services
				recognized under state law to prevent, correct or ameliorate disease or
				abnormalities detected by screening or by diagnostic procedures. Treatment for
				conditions discovered through a screen may exceed limits of the Medicaid
				Program. Services not otherwise covered under the Medicaid Program will be
				considered for coverage if the services are prescribed by a physician as a
				result of an EPSDT screen. The services must be medically necessary and
				permitted under federal Medicaid regulations.
215.110
Immunization Record
The child's immunization status should be assessed from the
				child's health record. If the child needs any immunization at the time of the
				screening, the immunization(s) will be administered as part of the screening
				process.
Immunizations for childhood diseases are exempt from primary
				care physician (PCP) referral requirements.
The Arkansas Medicaid program recommends that EPSDT providers
				follow the immunization schedule shown below as approved by the Advisory
				Committee on Immunization Practices (ACIP), the American Academy of Pediatrics
				(AAP) and the American Academy of Family Physicians (AAFP).
The current immunization schedule indicates the recommended
				ages for routine administration of currently licensed childhood vaccines, as of
				December 1, 2004, for children through age 18 years. More information about the
				current immunization schedule may be found on the AAP Web site at
www.aap.org/policv/021
2.html
.
View or print the Recommended Childhood Immunization
				Schedule.
Any dose not given at the recommended age should be given at
				any subsequent visit when indicated and feasible. Additional vaccines may be
				licensed and recommended during the year. Licensed combination vaccines may be
				used whenever any components of the combination are indicated and the vaccine's
				other components are not contraindicated. Providers should consult the
				manufacturers' package inserts for detailed recommendations.
A. Hepatitis B vaccine (HepB)
1. All infants should receive the first dose
			 of hepatitis B vaccine soon after birth and before hospital discharge. The
			 first dose may also be given by the age of 2 months if the infant's mother is
			 HBsAg-negative. Only monovalent HepB can be used for the birth dose. Monovalent
			 or combination vaccine containing HepB may be used to complete the series. Four
			 doses of vaccine may be administered when a birth dose is given. The second
			 dose should be given at least 4 weeks after the first dose, except for
			 combination vaccines, which cannot be administered before age 6 weeks. The
			 third dose should be given at least 16 weeks after the first dose and at least
			 8 weeks after the second dose. The last dose in the vaccination series (third
			 or fourth dose) should not be administered before age 24 weeks.
2. Infants born to HBsAg-positive mothers
			 should receive HepB and 0.5 mL Hepatitis B Immune Globulin (HBIG) at separate
			 sites within 12 hours of birth. The second dose is recommended at age 1-2
			 months. The last dose in the vaccination series should not be administered
			 before age 24 weeks. These infants should be tested for HBsAg and anti-HBs at
			 9-15 months of age.
3. Infants born
			 to mothers whose HBsAg status is unknown should receive the first dose of the
			 HepB series within 12 hours of birth. Maternal blood should be drawn as soon as
			 possible to determine the mother's HBsAg status; if the HBsAg test is positive,
			 the infant should receive HBIG as soon as possible but no later than 1 week of
			 age. The second dose is recommended at age 1-2 months. The last dose in the
			 vaccination series should not be administered before age 24 weeks.
B. Diphtheria and tetanus toxoids
			 and acellular pertussis vaccine (DTaP)
1. The
			 fourth dose of DTaP may be administered as early as age 12 months, provided 6
			 months have elapsed since the third dose and the child is unlikely to return at
			 age 15-18 months. The final dose in the series should be given at age 4 years
			 or older.
2. Tetanus and diphtheria
			 toxoids (Td) are recommended at age 11-12 years if at least 5 years have
			 elapsed since the last dose of tetanus and diphtheria toxoid-containing
			 vaccine. Subsequent routine Td boosters are recommended every 10
			 years.
C. Haemophilus
			 (Hemophilus) influenzae type b (Hib) conjugate vaccine
Three Hib conjugate vaccines are licensed for infant use. If
				PRP-OMP [PedvaxHIB® or ComVax® (Merck)] is administered at ages 2 and 4
				months, a dose at age 6 months is not required. DTaP/Hib combination products
				should not be used for primary immunization in infants at ages 2, 4 or 6
				months, but they can be used as boosters following any Hib vaccine. The final
				dose in the series should be given at age 12 months or older.
D. Measles, mumps, and rubella vaccine (MMR)
The second dose of MMR is recommended routinely at age 4-6
				years but may be administered during any visit, provided at least 4 weeks have
				elapsed since the first dose and that both doses are administered beginning at
				or after age 12 months. Those who have not previously received the second dose
				should complete the schedule by the visit at age 11 or 12 years.
E. Varicella vaccine
Varicella vaccine is recommended at any visit at or after age
				12 months for susceptible children (i.e., those who lack a reliable history of
				chickenpox). Susceptible persons
>
13 years of age
				should receive 2 doses, given at least 4 weeks apart.
F. Pneumococcal vaccine
1. The heptavalent pneumococcal conjugate
			 vaccine (PCV) is recommended for all children ages 2-23 months. It is also
			 recommended for certain children ages 24-59 months. The final dose in the
			 series should be given at age 12 months or older.
2. Pneumococcal polysaccharide vaccine (PPV)
			 is recommended in addition to PCV for certain high-risk groups. See
MMWR 2000; 49 (RR-9) 1-35
.
G. Hepatitis A vaccine
Hepatitis A vaccine is recommended for children and adolescents
				in selected states and regions and for certain high-risk groups; consult your
				local public health authority. Children and adolescents in these states and
				regions, and high-risk groups who have not been immunized against hepatitis A,
				can begin the hepatitis A immunization series during any visit. The two doses
				in the series should be administered at least 6 months apart. See
MMWR
				1999; 48 (RR-12); 1-37
.
Note: Arkansas is not one of the selected states in which
				Hepatitis A immunizations are recommended. The recommendations could change,
				however, if there is an increase in the number of reported cases of Hepatitis
				A.
H. Influenza vaccine
Influenza vaccine is recommended annually for children age
>
6 months with certain risk factors (including but
				not limited to asthma, cardiac disease, sickle cell disease, HIV and diabetes)
				healthcare workers and other persons (including household members) in close
				contact with persons in groups at high risk (see
MMWR 2004; 53(RR-6);
				1-40
) and can be administered to all others wishing to obtain
				immunity. In addition, healthy children, ages 6-23 months, and close contacts
				of healthy children aged 0-23 months are recommended to receive influenza
				vaccine because children in this age group are at substantially increased risk
				for influenza-related hospitalizations. For healthy persons aged 5 through 49
				years (please note: EPSDT does not cover services provided to individuals age
				21 and over), the intranasally administered live, attenuated influenza vaccine
				(LAIV) is an acceptable alternative to the intramuscular trivalent inactivated
				influenza vaccine (TIV). Children receiving TIV should be administered a dosage
				appropriate for their age (0.25 mL if age 6-35 months or 0.5 mL if [GREATER
				THAN]3 years). Children age [LESS THAN]8 years that are receiving influenza
				vaccine for the first time should receive two doses (separated by at least 4
				weeks for TIV and at least 6 weeks for LAIV).
215.120
Vaccines for Children
The Vaccines for Children (VFC) Program was established to
				enable free access to childhood immunizations for Medicaid-eligible children
				under nineteen years of age.
Arkansas Medicaid reimburses for the administrative fee for
				immunizations included in the Vaccines for Children (VFC) Program, which is
				administered by the Arkansas Department of Health (ADH). Providers may obtain
				the approved vaccines from the Department of Health.
To enroll in the VFC Program and obtain the vaccines, providers
				may contact the Arkansas Department of Health.
View or print
				the Arkansas Department of Health contact
				information
.
242.100
Procedure Codes
See section 212.000 for EPSDT screening terminology.
An EPSDT periodic complete medical screen includes both hearing
				and vision screens. Providers
must not
bill an EPSDT periodic or
				Interperiodic vision or hearing screen on the same day or within 7 days of an
				EPSDT complete medical screen by the same or different providers. The above
				billing combinations represent a duplication of services.
An EPSDT interperiodic full medical screen includes both
				hearing and vision screens. Providers
must not
bill an EPSDT
				periodic or Interperiodic vision screen on the same day or within 7 days of an
				EPSDT Interperiodic full medical screen by the same or different providers. The
				above billing combinations represent a duplication of services.
Claims for EPSDT medical screenings must be billed
				electronically or using the DMS-694 EPSDT paper claim form.
View or print a DMS-694 sample claim
				form.
National Code
Modifier 1
Modifier 2
Description
99381-99385
EP
U1
EPSDT Periodic Complete Medical Screen (New
						  Patient)
99391-99395
EP
U2
EPSDT Periodic Complete Medical Screen (Established
						  Patient)
99381-99385
EP
EPSDT Interperiodic Full Medical Screen (New
						  Patient)
99391-99395
EP
EPSDT Interperiodic Full Medical Screen (Established
						  Patient)
99391-99395
EP
52
Partial Medical Screen/Reassessment EPSDT health and
						  developmental history, including assessment of physical development
						  (Established Patient)
96151
EP
Partial Medical Screen/Reassessment EPSDT health and
						  developmental history, including assessment of mental development
99381-99385
EP
52
Partial Medical Screen/Reassessment EPSDT unclothed
						  physical assessment (New Patient)
99391-99395
EP
U1
Partial Medical Screen/Reassessment EPSDT unclothed
						  physical assessment (Established Patient)
994311
994321
994351
EP
i
Initial Newborn Care/EPSDT screen in
						  hospital
991731
EP
EPSDT Periodic Vision Screen
V5008
EP
EPSDT Periodic Hearing Screen
V5008
EP
U1
EPSDT Interperiodic Hearing Screen
D01201
CHS/EPSDT Oral Examination
D01401
EPSDT Interperiodic Dental Screen, with prior
						  authorization
920121
EP
TS
EPSDT Interperiodic Vision Screen
99401
EP
EPSDT Health Education - Preventive IVIedical
						  Counseling
364152
Collection of venous blood by venipuncture
83655
Lead
1 Exempt from PCP referral
				requirements
2 Covered when specimen is referred
				to an independent lab
Immunizations and laboratory tests may be billed separately
				from comprehensive screens.
The verbal assessment of lead toxicity risk is part of the
				complete CHS/EPSDT screen. The cost for the administration of the risk
				assessment is included in the fee for the complete screen.
Laboratory/X-ray and immunizations associated with an EPSDT
				screen may be billed on the DMS-694 EPSDT claim form.
When billing on paper, the EPSDT screening services must be
				billed with a type of service code "6."
For billing on paper, immunizations must be billed with a type
				of service code "1."
242.110
Newborn Care
For routine newborn care following a vaginal delivery or
				C-section, procedure code
99431, 99432
or
99435
should be used one time to cover all newborn care visits by the
				attending physician. Payment of these codes is considered a global rate and
				subsequent visits may not be billed in addition to codes
99431, 99432
and
99435.
These procedure codes include the physical exam
				of the baby and the conference(s) with newborns parent(s) and is considered to
				be the initial newborn care/EPSDT screen in hospital. These procedure codes
				should not be used for illness care (e.g. neonatal jaundice). Providers may
				refer to the physician manual for necessary illness codes.
The procedure codes must be billed on the Centers for Medicaid
				and Medicare Services (CMS) billing form, titled the CMS-1500, or
				electronically.
View or print a CMS-1500 sample
				form.
242.120
Exceptions to DMS-694 EPSDT Claim Form Billing Procedures
All EPSDT procedure codes must be billed on the DMS-694 EPSDT
				claim form with the following exceptions.
A. Dental Billing
1. Procedure code
D0120
must be
			 billed on the American Dental Association (ADA) claim form.
View or print the ADA claim
			 form.
2. Prior
			 authorization for procedure code
D0140
must be requested on the
			 ADA claim form.
3. Procedure code
D0140
for an interperiodic dental screen must be billed on the ADA
			 claim form.
B. Procedure
			 codes
99201
through
99215
(Office Medical Services),
99341
through
99353
(home medical services) and
99221
through
99223
(hospital inpatient medical
			 services) are not EPSDT services and may not be billed on the DMS-694 EPSDT
			 claim form. The procedure codes must be billed on the CMS-1500 or
			 electronically.
View or print a CMS-1500 sample
			 form.
C.
			 Providers are not limited to diagnosis codes V20.0, V20.1, V20.2 and V79.3 when
			 billing EPSDT screening codes.
D.
			 Providers billing for immunizations should use the appropriate CPT or locally
			 assigned procedure code for the specific immunization. The immunization
			 procedure codes and descriptions may be found in the CPT book. Providers may
			 bill the immunization procedure codes on either the DMS-694 EPSDT claim form,
			 the CMS-1500 claim form or electronically.
View or print a
			 CMS-1500 sample form.
242.130
Restrictions on Duplication of
			 Services
Services must be filed with the appropriate national procedure
				codes and applicable modifiers.
A. The
			 following procedure codes with the applicable modifier represent an EPSDT
			 Periodic Complete Medical Screen that includes both hearing and vision screens.
EPSDT Periodic Complete Medical Screen claims must be filed
				with the appropriate CPT-4 procedure codes and modifier. Procedure codes
99381
through
99385
(New Patient), with modifiers EP
				and U1, and procedure codes
99391
through
99395
(Established Patient), with modifiers EP and U2, will represent an EPSDT
				periodic complete medical screen, which includes both hearing and vision
				screens.
Immunizations and laboratory tests may be billed
				separately.
Example for EPSDT Periodic Complete Screen for an
				established patient:
99391, Modifiers EP and U2 = EPSDT Periodic Complete Medical
				Screen
B. The following
			 procedure codes with applicable modifiers represent an EPSDT Interperiodic Full
			 Medical Screen that includes both hearing and vision screens.
EPSDT Interperiodic Full Medical Screen claims must be filed
				with the appropriate CPT-4 procedure codes and modifiers: procedure codes
99391
through
99395
(Established Patient) with
				modifier EP, and procedure codes
99381
through
99385
(New Patient) with modifier EP.
Immunizations and laboratory tests may be billed
				separately.
Example for EPSDT Interperiodic Full Medical Screen for
				an established patient:
99391, Modifier EP = Interperiodic Full Medical Screen
				(Established Patient)
*Procedure codes
99381
through
99385
(New Patient) with modifier EP should only be used to bill an EPSDT
				Interperiodic Full Medical Screen for new patients, ages 0 through 20 years of
				age, who have already received an EPSDT Periodic Complete Medical Screen by
				another provider within the current fiscal year.
242.140
Vaccines for Children
			 Program
Vaccines available through the VFC program are covered for
				Medicaid-eligible children. Only the administrative fee is reimbursed. When
				filing claims for administering VFC vaccines, providers must use the CPT
				procedure code for the vaccine administered. Electronic and paper claims
				require modifiers EP and TJ. When filing paper claims, type of service code "6"
				and the modifiers EP and TJ must be entered on form DMS-694.
View or print a DMS-694 sample claim
				form.
Medicaid policy regarding immunizations for adults remains
				unchanged by the VFC program.
The following list contains the vaccines available through the
				VFC program.
Vaccine Description
Procedure Code
Modifier 1
Modifier 2
Hemophilus influenza b (Hib) conjugate (4 dose
						  schedule) for intramuscular use
90645
EP
TJ
Hemophilus influenza b (Hib) PRP-D conjugate for
						  booster use only, intramuscular use
90646
EP
TJ
Hemophilus influenza b (Hib) PRP-OMP conjugate (3 dose
						  schedule), for intramuscular use
90647
EP
TJ
Influenza virus vaccine, split virus, preservative
						  free, for children 6-35 months of age, for intramuscular use
90655
EP
TJ
Influenza virus vaccine, split virus, for children 6-35
						  months of age, for intramuscular use
90657
EP
TJ
Influenza virus vaccine, split virus, for use in
						  individuals 3 years and above, for intramuscular use
90658
EP
TJ
Pneumococcal conjugate vaccine polyvalent, for children
						  under 5 years, for intramuscular use
90669
EP
TJ
Diphtheria, tetanus toxoids and acellular pertussis
						  vaccine (DtaP), for intramuscular use
90700
EP
TJ
Diptheria and tetanus toxoids (DT) absorbed for use in
						  individuals younger than 7 years, for intramuscular use
90702
EP
TJ
Measles, mumps and rubella virus vaccine (MMR), live,
						  for subcutaneous use
90707
EP
TJ
Poliovirus vaccine, any type(s) (OPV), live, for oral
						  use
90712
EP
TJ
Poliovirus vaccine, inactivated (IPV), for subcutaneous
						  use
90713
EP
TJ
Varicella virus vaccine, live, for subcutaneous
						  use
90716
EP
TJ
Tetanus and diphtheria toxoids (Td) absorbed for use in
						  individuals 7 years or older, for intramuscular use
90718
EP
TJ
Diphtheria, tetanus toxoids and whole cell pertussis
						  vaccine and Hemophilus influenza B vaccine (DTP-Hib) for intramuscular
						  use
90720
EP
TJ
Diphtheria, tetanus toxoids and acellular pertussis
						  vaccine and Hemophilus influenza B vaccine (DtaP-Hib), for intramuscular
						  use
90721
EP
TJ
Diphtheria, tetanus toxoids and acellular pertussis
						  vaccine and Hemophilus influenza B vaccine (DtaP-Hib), for intramuscular
						  use
90723
EP
TJ
Hepatitis B vaccine, adolescent (2 dose schedule), for
						  intramuscular use
90743
EP
TJ
Hepatitis B vaccine, pediatric/adolescent (3 dose
						  schedule), for intramuscular use
90744
EP
TJ
242.150
Limitation for Laboratory Procedures Performed as Part of
			 EPSDT