EPSDT billing (Medicaid patients only)
Use these codes when reporting early and periodic screening, diagnosis and treatment (EPSDT) "Normal Newborn" or "Well Child" exams of Medicaid patients.
Go to the www.mich.gov website for the EPSDT Guidelines. This link opens a new browser window.
Another resource is the American Academy of Pediatrics' "Bright Futures" website. Scroll down their web page to find the AAP Periodicity Schedule.
Go to the Bright Futures website. This link opens a new browser window.
| Code(s) | Description |
|---|
| New patient visits |
|
| 99460 |
History & physical of inpatient "Normal Newborn" |
99463
|
History & physical of newborn for same day discharge |
| 99381 |
Initial evaluation, under age of 1 year |
| 99382 |
Initial evaluation, age 1-4 years |
| 99383 |
Initial evaluation, age 5-11 years |
| 99384 |
Initial evaluation, age 12-17 years |
| 99385 |
Initial evaluation, age 18-21 |
| Established patient visits |
|
| 99391 |
Reevaluation, under age of 1 year |
| 99392 |
Reevaluation, age 1-4 years |
| 99393 |
Reevaluation, age 5-11 years |
| 99394 |
Reevaluation, age 12-17 years |
| 99395 |
Reevaluation, age 18-21 years |
EPSDT-required services that may be billed separately
|
When performed according to the periodicity table. For complete descriptions, refer to the Physician's Current Procedural Terminology code book. |
| 85014 |
Hematocrit |
| 85018 |
Hemoglobin |
| 81002 |
Urine testing with standardized reagent dipstick for sugar & albumin |
| 90632-90749 |
Immunizations
Continue to obtain the serum from local health department
|
| 86580 or 86585 |
Tuberculin testing (TB) |
90465, 90467, 90471, 90473
|
One vaccine |
90466, 90468, 90472, 90474
|
Subsequent vaccines
Must bill administration code and immunization code, even if immunization serum was free. |
90470
|
H1N1 administration
|
| 96110 |
Developmental testing, limited (e.g., developmental screening test II, early language milestone screen) with interpretation and report
|
96111
|
Developmental testing, extended (includes assessment of motor, language, social, adaptive and/or cognitive functioning by standarized developmental instruments) with interpretation and report |
