Appendix A Well Child Check-Up (EPSDT)

Well Child Check-Up
If the primary insurance is not a HMO, bill the appropriate “office visit” code.
Once the claim has been paid/denied from the patient’s other insurance, a claim
may be filed with Medicaid utilizing the same “office visit” code with an EP
modifier appended. When billing an office visit code for an interperiodic code,
always append the EP modifier or the visit will count against benefit limits.
NOTE:
If any other treatments are provided the same day (injections, lab, etc.), a “1” or
“4” must also be reflected in Block 24h, on each line item, or the claim will deny.
NOTE:
Effective January 1, 2007 and thereafter, interperiodic screening codes have
changed. The codes for interperiodic screenings must be billed with an EP
modifier and are as follows:
99211 EP through 99215 EP for office and/or outpatient interperiodic
screenings
99233 EP for Inpatient interperiodic screenings
The new interperiodic screening codes will count against office /hospital visit
limits if billed without an EP modifier.
The Evaluation and Management code level of care chosen must be supported
by medical record documentation.
Each child’s primary insurance must be billed first, and then Medicaid as the
payor of last resort.
See page A-24 for a crosswalk of codes used for Interperiodic Screenings.
A-24 January 2011