Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.08-031 - Child Health Services / Early and Periodic Screening, Diagnosis, and Treatment Provider Manual Update Transmittal #103

Current through Register Vol. 49, No. 6, June, 2024
Section II
Child Health Services/Early
			 and Periodic Screening, Diagnosis, and Treatment
214.300
Foster Care Intake Physical
			 Examination in the EPSDT Program
Arkansas Medicaid beneficiaries entering the Arkansas foster
				care system are required to receive an intake physical examination within the
				first seventy two (72) hours. If the EPSDT provider who performs the screening
is not
the beneficiary's PCP, the intake physical
				examination should be billed with procedure codes
99381-99385
and
				modifiers
EP
and
H9
. Billing with these procedure
				codes and modifiers will allow the claim to be submitted for payment without a
				referral from the beneficiary's PCP and will alert the system not to count the
				screen toward the beneficiary's yearly EPSDT periodic complete medical
				screening limits.
If the EPSDT provider who performs the screen
is
the beneficiary's PCP, the intake physical exam
				should be billed with procedure codes
99391-99395
and modifiers
EP
and
H9
. Billing with these procedure codes and
				modifiers will allow the claim to be submitted for payment and will not count
				toward the beneficiary's yearly EPSDT periodic complete medical screening
				limits.
Procedure codes
99381-99385
and
99391-99395,
in conjunction with the
EP and H9 modifiers,
are to be
				used only for the required intake physical examination for Medicaid
				beneficiaries in the Arkansas foster care system.
242.100
Procedure Codes
The table below contains procedure codes, the associated
				modifiers to be used with the individual code, and a description of each EPSDT
				service.
Other coding information found in the chart:
1 Exempt from PCP referral
				requirements
2 Covered when specimen is referred
				to an independent lab
Electronic and paper claims require use of modifiers. When
				filing paper claims for an EPSDT screening service, the applicable modifier
				must be entered on the claim form.
See section
				212.000 for EPSDT screening
				terminology.
NOTES
A.
			 A primary care physician (PCP) may bill a sick visit and a Child Health
			 Services (EPSDT) periodic screening for a patient on the same date of service
			 if the screening is due to be performed.
B. Procedure codes
99381-99385
and
99391-99395,
used in conjunction with the
EP and H9
			 modifiers,
are to be used only for the required intake physical
			 examination for Medicaid beneficiaries in the Arkansas foster care system. (See
			 section 214.300 for more
			 information.)
C. 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.
D. Laboratory/X-ray and immunizations
			 associated with an EPSDT screen may be billed on the DMS-694 EPSDT claim
			 form.
E. Immunizations and
			 laboratory tests may be billed separately from comprehensive screens.
F. 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.
Procedure Code
Modifier 1
Modifier 2
Description
99381-99385
EP
U1
EPSDT Periodic Complete Medical Screen (New
						  Patient)
99381-993851
EP
H9
EPSDT Periodic Complete Medical Screen (Foster
						  Care)
99391-99395
EP
U2
EPSDT Periodic Complete Medical Screen (Established
						  Patient)
99391-993951
EP
H9
EPSDT Periodic Complete Medical Screen (Foster
						  Care)
994311 994321
							 994351
Initial Newborn Care/EPSDT screen in hospital
991731
EP
EPSDT Periodic Vision Screen
V50081
EP
EPSDT Periodic Hearing Screen
DO1201
CHS/EPSDT Oral Examination
D01401
EPSDT Interperiodic Dental Screen, with prior
						  authorization
99401
EP
EPSDT Health Education - Preventive Medical
						  Counseling
364152
Collection of venous blood by venipuncture
83655
Lead