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Attention providers:
The Health Care Authority (HCA) sent a provider alert on April 23, 2025, informing providers claims may be submitted for reimbursement, through June 30, 2025, without an ICD-10-CM diagnosis code and modifier for developmental and behavioral health screening(s).
As a reminder, effective for claims with dates of service on and after July 1, 2025, providers must submit the appropriate CPT® code for development and behavioral health screening(s) accompanied by both of the following:
- An ICD-10-CM diagnosis code
- A modifier to indicate whether the screening identified a need
Review the EPSDT Periodic Screening FAQ for more information on this requirement.
Have questions or want to connect?
HCA will update the EPSDT Well-Child Program Billing Guides by July 1, 2025, to reflect this requirement. If you have questions regarding the revisions to the EPSDT Well-Child Program Billing Guide, please contact the Apple Health Clinical Inbox.
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