016.06.05 Ark. Code R. 017
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."
016.06.05 Ark. Code R. 017