Apple Health (Medicaid) Provider Alert
Attention EPSDT providers:
The Health Care Authority (HCA) has revised the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Billing Guide, effective July 1, 2022.
What has changed?
Changes include:
- A revised program overview with additional descriptions of the components of the EPSDT program
- Additional information differentiating developmental surveillance and developmental screening
- Additional information regarding referrals to Early Supports for Infants and Toddlers (ESIT)
- The inclusion of topic examples for anticipatory guidance to families
- A restructured What if a problem is identified during an EPSDT well-child checkup? section
- The inclusion of a new section on billing for stand-alone vaccine counseling. Note: Due to guidance from the Centers for Medicare and Medicaid Services (CMS), this vaccine counseling policy may change.
- The restructuring and rewriting of sections of the guide to improve clarity and usability
- A revised common referral list
- The addition of helpful billing guidance
See the What has changed table in the guide for more details.
HCA updates provider billing guides quarterly, as needed. Providers may access the most up-to-date versions of guides at the Provider billing guides and fee schedules webpage.
Have questions or want to connect?
If you would like to connect with the HCA EPSDT team, contact either of the following:
-
Beth Tinker, PhD, MPH, MH, RN, Nursing Consultation Advisor
-
Christine Cole, LCSW, IMH-E ®, Infant-Early Childhood Mental Health Program Manager
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