Early and 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 a 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, we can help.
For more resources, please visit the Division of Public and Behavioral Health's Child and Adolescent Health Program
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 under age 21 years old. 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. Children born to Medicaid-eligible pregnant women are eligible for Medicaid for the first year of life of the child 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 Women, Infants and Children (WIC), a food supplement program for women and children. Your local Welfare Office can provide you with application information for WIC services. If you are eligible for WIC or Temporary Assistance for Needy Families (TANF), your children may be eligible for Medicaid and receive Healthy Kids benefits.
The best way to determine your eligibility is to make an appointment with an eligibility worker at your local Nevada State Welfare District Office. 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
FOR PROVIDERS
Healthy Kids is Nevada’s federally-required Early and Periodic Screening Diagnosics and Treatment (EPSDT) program. 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 (see link at right).
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 members 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. Interperiodic exams may be performed when requested or based on medical necessity.
A screening form is available for providers to use when performing the Healthy Kids screening exams. This form simply acts as a reminder by listing all the components of the screening, making it more streamlined for providers completing the exam. The form will not need to be returned to Nevada Medicaid, but it should remain part of the recipient’s medical record.
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 visits, consultations, hematocrit, urinalysis dip stick, lead screening, and objective vision and hearing.
Medically-necessary health care, treatment or other measures to correct or improve 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 Nevada Medicaid 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 at the HCP Provider Portal. For consideration, the services must have enough information to be safe, effective, justify medical necessity, and must not be considered experimental or investigational.
REFERRALS AND DIAGNOSTICS
A dated, written referral should be given to the member, parent/guardian or referral service provider that documents the need for referral or follow-up.
CODING AND BILLING GUIDELINES
Healthy Kids Exams 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.