Updates to the EPSDT Billing Guide

Washington State Health Care Authority sent this bulletin at 01/02/2023 04:00 PM PST

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Updates to the EPSDT Billing Guide

The Health Care Authority (HCA) revised the Early and Periodic, Screening, Diagnosis, and Treatment (EPSDT) Billing Guide, effective for dates of service on and after January 1, 2023.

These changes reflect new policies to align with American Academy of Pediatrics (AAP) Bright Futures recommendations as well as HCA’s 12-month postpartum coverage. See HCA's After-Pregnancy Coverage webpage.

EPSDT Periodicity Expansion

Effective for dates of service on and after January 1, 2023, HCA’s Apple Health (Medicaid) well-child checkup schedule includes:

Six checkups before age one.
Seven checkups between age one and four.
One checkup every 365 days between age five and up to age twenty-one.

Caregiver and Maternal depression screening

Recognizing the prevalence of perinatal mental health conditions and to align with HCA’s 12-month postpartum coverage, HCA implemented a policy change for caregiver and maternal depression screenings during EPSDT well-child checkups.

Effective for dates of service on and after January 1, 2023, caregiver and maternal depression screening is required at well-child checkups for caregivers and mothers of infants through 12 months of age.

See the "What has changed" table in the EPSDT billing guide for more details about these policies and additional updates.

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?

To connect with the HCA EPSDT team, contact either:

Beth Tinker, PhD, MPH, RN, Nursing Consultation Advisor
Christine Cole, LCSW, IMH-E ®, Infant-Early Childhood Mental Health Program Manager

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About the Health Care Authority (HCA)

The Washington State Health Care Authority (HCA) is committed to whole-person care, integrating physical health and behavioral health services for better results and healthier residents.

HCA purchases health care for more than 2.5 million Washington residents through Apple Health (Medicaid), the Public Employees Benefits Board (PEBB) Program, the School Employees Benefits Board (SEBB) Program, and the COFA Islander Health Care Program. As the largest health care purchaser in the state, we lead the effort to transform health care, helping ensure Washington residents have access to better health and better care at a lower cost.

Please do not reply directly to this message. For more information, visit the HCA website, where you'll also find contact information.

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The Washington State Health Care Authority (HCA) complies with all applicable federal and Washington state civil rights laws and is committed to providing equal access to our services. Visit HCA’s website to view complete nondiscrimination statements.