Early Periodic Screening, Diagnostic and Treatment (EPSDT)
WHAT IS HEALTHY KIDS?
Healthy Kids is a program for Nevada's children - to ensure a healthy, happy childhood and productive life. We are dedicated to giving Nevada's children regular, preventive health care.
- Do your children need glasses?
- Dental care?
- Are they having problems in school?
- Do they need immunizations?
- Do you have questions about your child's growth and development?
If you have any concerns about your children’s health, "HEALTHY KIDS" CAN HELP YOU - we all want Nevada's children to grow up healthy.
EPSDT TOOLKIT FOR HEALTHY KIDS
For family-friendly education and outreach materials or screen/exam tools for providers please visit the EPSDT Toolkit for Healthy Kids website (under Links). The materials found in the EPSDT toolkit are produced by active community representatives and state personnel to increase the number of physicians conducting Healthy Kids preventive services (screenings and exams) and to increase the number of children and teens who receive Healthy Kids screenings. This is a partnership among the state Title V agency (Bureau of Family Health Services in Nevada), Medicaid and Nevada Check Up to do outreach and increase utilization rates (See Association of Maternal & Child Health Programs under Links).
HEALTHY KIDS’ SERVICES AND WHO QUALIFIES
Healthy Kids is a program which provides preventive health care such as immunizations, yearly physicals and referrals for health problems of Medicaid eligible infants, children and young adults This program encourages referrals for developmental problems, vision, hearing and dental problems as well as family problems.
Healthy Kids is available to individuals eligible for Medicaid and Nevada Check-Up from birth to age 21. Children born to Medicaid eligible pregnant women are eligible for Medicaid for the first year of life regardless of changes in income level of the family. These children are automatically eligible for the Healthy Kids program. If your family is eligible for Healthy Kids, you may also be eligible for WIC, a food supplement program for women and children. Your local Welfare Office can provide you with information on how to apply for WIC services. Additionally, if you are eligible for Women, Infants and Children (WIC) or Temporary Assistance for Needy Families (TANF), your children may be eligible for Healthy Kids.
The best way to determine your eligibility is to make an appointment with an eligibility worker at your local Nevada State Welfare District Office. A link is provided above. You will need to bring these items with you:
- Receipts for rent and utilities
- Paycheck stubs
- Birth certificates
- Social Security cards
- Marriage/Divorce papers
- If a registered undocumented citizen, proof of registration
Healthy Kids is Nevada’s federally-required Early Periodic Screening Diagnosis and Treatment (EPSDT). The following contains information for Healthy Kids providers regarding screening exams, referrals from a screening exam and treatment provided as a result of a screening exam. This information is outlined in greater detail in the Medicaid Services Manual (MSM) Chapter 1500 – Healthy Kids.
Healthy Kids screening exams are preventative and diagnostic services designed to evaluate the general physical and mental health, growth, development and nutritional status of eligible recipients under the age of 21 years old. The Healthy Kids program encourages providers to follow the recommended periodicity schedule set forth by the American Academy of Pediatrics. See current recommendations/guidelines on the Bright Futures Website (Under Links). Interperiodic exams may be performed when requested or based on medical necessity.
A screening form is available as an option for providers to use when performing the Healthy Kids screening exams. The form acts as a reminder by listing all the components of the screening, making it more streamlined for providers to complete the exam. The form will not need to be returned to Nevada Medicaid and should remain part of the recipient’s medical record. Links for the form, along with a guideline, can be found at the bottom of this webpage.
Screening services (including examinations and diagnostics) do not require prior authorization, however, ongoing treatment or services beyond the initial screening may require prior authorization based on specific program requirements. The following services are included in the screening exam and should not be billed separately: office visit, consultations, hematocrit, urinalysis dip stick, PPD or tine test, lead screening, objective vision and hearing.
Medically necessary health care, treatment or other measures to correct or ameliorate defects and physical and mental illnesses or conditions discovered by Healthy Kids screening services are a covered benefit, even if those services are not included as part of the covered services in the state plan. Requests for services that are beyond specific program policy or not covered under state plan must be made to the QIO-like vendor. For consideration, the services must have enough information to justify medical necessity; be safe, effective and not considered experimental or investigational.
The Healthy Kids benefit package is not available to recipients who are eligible solely because of pregnancy.
REFERRALS AND DIAGNOSTICS
A dated written referral should be given to the recipient, parent/guardian or referral service provider that documents the need for referral or follow up.
CODING AND BILLING GUIDELINES
Healthy Kids screenings should be billed using the most appropriate codes (99381-99385 or 99391-99385) with either modifier EP or TS. Use of modifier EP is for routine screening. Use of modifier TS indicates that referral or follow up is indicated. When using modifier TS, be sure to complete field 21 on the CMS-1500 claim form with the appropriate diagnosis code to reflect the condition requiring follow up.