016-06-08 Ark. Code R. § 31

Current through Register Vol. 49, No. 6, June, 2024

Rule 016.06.08-031 - Child Health Services / Early and Periodic Screening, Diagnosis, and Treatment Provider Manual Update Transmittal #103

Section II Child Health Services/Early and Periodic Screening, Diagnosis, and Treatment

214.300Foster 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.

242.100Procedure 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

016.06.08 Ark. Code R. § 031

9/4/2008