EPSDT Billing Guide Reorganization

Washington State Health Care Authority sent this bulletin at 04/04/2023 02:18 PM PDT

Apple Health (Medicaid) Provider Alert

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

These changes are intended to improve usability and clarify the scope of the EPSDT Well-Child Program.

What has changed?

New title (formerly referenced as the EPSDT Program Billing Guide)
Added information about the purpose of this guide
Reorganized content, sections, and structure for improved useability
New sections for foster care and “What if a problem is identified during an EPSDT well-child check?”
Updated periodicity requirements for middle childhood and adolescence from 365 days to every calendar year

See the "What has changed?" table in the EPSDT Well-Child Program 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.