EPSDT well-child checkup policy change
The Health Care Authority (HCA) has updated the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) policies related to the well-child checkup periodicity schedule.
This change aligns Apple Health (Medicaid) policy with the American Academy of Pediatrics (AAP) Bright Futures recommendations and increases the frequency of well-child checkups.
Effective for claims with dates of service on and after January 1, 2023, the EPSDT 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.
HCA is revising the EPSDT billing guide to reflect these changes and will publish the revised guide shortly.
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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