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Billing for EPSDT (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.

Code(s) Description
New Patient Visits

99431 History & physical of inpatient "Normal Newborn"
99435
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
90700-90749 Immunizations
Continue to obtain the serum from local health department
86580 or 86585 Tuberculin testing (TB)
90471 One vaccine
90472 Subsequent vaccines
Must bill administration code and immunization code, even if immunization serum was free.
96110 Denver II test
Remarks section must note "Denver II Test was performed for EPSDT"
99341 Blood lead educational visit using dx code 984.0-984.9
(go to table of drugs & chemical for specificity)


Last modified 01/11/08