Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.05-017 - Child Health Services/Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Update #63

Current through Register Vol. 49, No. 6, June, 2024
Section II
Child Health Services/Early and Periodic Screening, Diagnosis, and
			 Treatment
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.
Procedure 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
UB
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
UB
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 EP EP
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 Medical
						  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."