Child Health Check-Up (formerly EPSDT) - Herman & Associates ...

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Child Health Check-Up Coverage and Limitations HandbookProcedure Code InformationProcedure CodesThe procedure codes listed in this handbook are Healthcare Common ProcedureCoding System (HCPCS) codes. Codes described in the Physician’s CurrentProcedure Terminology (CPT) book are part of the HCPCS code system.Please refer to the CPT book for complete descriptions of the standard codes.Effective with dates of service on or after October 16, 2003, in compliance withthe federal requirements found in the Health Insurance Portability andAccountability Act (HIPAA), Florida Medicaid will process claims for only thestandard code sets allowed in the federal legislation.All previously used “local codes” can no longer be processed by the FloridaMedicaid claims processing system for Medicaid payment for dates of servicebeginning October 16, 2003. For dates of service prior to October 16, 2003, theprovider must use procedure codes that were payable at that time, which maybe submitted either electronically or on a paper claim form. Please refer to thefollowing listing for the valid codes for Florida Medicaid’s Child Health Check-Upservices effective October 16, 2003.New ProcedureCodes for Dates ofService BeginningOctober 16, 2003The new procedure codes for a Child Health Check-Up service are the CPTPreventive Medicine Services Codes. In some cases, one or two modifiers arerequired to uniquely identify the service provided. Both the procedure code andmodifiers listed must be completed on the claim in order to receive properreimbursement. No modifiers other than the ones listed in this chapter areallowed when billing these services.New PatientCode Modifier Description99381 Initial comprehensive preventive medicine evaluation andmanagement of an infant, age under 1 year99382 Initial comprehensive preventive medicine evaluation andmanagement of early childhood, age 1 through 4 years99383 Initial comprehensive preventive medicine evaluation andmanagement of late childhood, age 5 through 11 years99384 Initial comprehensive preventive medicine evaluation andmanagement of an adolescent, age 12 through 17 years99385 EP Initial comprehensive preventive medicine evaluation andmanagement of an 18 through 20 year old**Note: The EP modifier must be used with Procedure Code 99385 to identifychildren 18 through 20 years of age.3-2 October 2003
Child Health Check-Up Coverage and Limitations HandbookProcedure Code Information, continuedNew ProcedureCodes for Dates ofService BeginningOctober 16, 2003,continuedEstablishedPatientCode Modifier Description99391 Periodic comprehensive preventive medicine reevaluationand management of an infant, age under 1 year99392 Periodic comprehensive preventive medicine reevaluationand management of early childhood, age 1 through 4years99393 Periodic comprehensive preventive medicine reevaluationand management of late childhood, age 5 through 11years99394 Periodic comprehensive preventive medicine reevaluationand management of an adolescent, age 12 through 17years99395 EP Periodic comprehensive preventive medicine reevaluationand management of an 18 through 20 year old** Note: The EP modifier must be used with Procedure Code 99395 to identifychildren 18 through 20 years of age.Local Code forDates of ServicethroughOctober 15, 2003The Child Health Check-Up procedure code (W9881) and the procedure code(W9979) for Blood Lead (capillary) should be used through October 15, 2003.Diagnosis Code InformationDiagnosis CodesRequiredDiagnosis codes are found in the International Classification of Diseases, 9thEdition, Clinical Modifications (ICD-9-CM). The provider must enter the mostspecific diagnosis code(s) including the fourth and fifth digits, when available, onthe claim form.A diagnosis code is required for reimbursement of a Child Health Check-Upservice. See the Florida Medicaid Provider Reimbursement Handbook, CMS-1500 for paper claim submission. For electronic claim submission, contact theMedicaid fiscal agent EDI help desk at 800-829-0218.October 2003 3-3
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