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

Child Health Check-Up Coverage and Limitations HandbookReferral Code InformationRequired ChildHealth Check-UpReferral CodesFor Child Health Check-Up screening services, enter the referral code thatidentifies the health screening of the child:U Complete NormalIndicator is used when there are no referrals made.2 Abnormal, Treatment InitiatedIndicator is used when a child is currently undertreatment for referred diagnostic or corrective healthproblem.T Abnormal, Recipient ReferredIndicator is used for referrals to another provider fordiagnostic or corrective treatments or scheduled foranother appointment with check-up provider fordiagnostic or corrective treatment for at least one healthproblem identified during an initial or periodic check-up(not including dental referrals).V Patient Refused ReferralIndicator is used when the patient refused a referral.Note: See specific instructions for using these codes in the Florida MedicaidProvider Reimbursement Handbook, CMS-1500 for paper claim submission andfor electronic claim submission, contact the Medicaid fiscal agent EDI help deskat 800-829-218.Reimbursement InformationChild HealthCheck-Up ClaimForm withHIPAAImplementationFor paper claim submission, beginning with HIPAA implementation, a ChildHealth Check-Up service must be billed on the CMS-1500 claim form.Note: See the Medicaid Provider Reimbursement Handbook, CMS-1500 forinstructions on completing the claim form.Note: For electronic claim submission, beginning with HIPAA implementation,contact the Medicaid fiscal agent EDI help desk at 800-829-0218.Child HealthCheck-UpReimbursementTo be reimbursed, Child Health Check-Up providers must assess and documentin the child’s medical record all the required components of a Child HealthCheck-Up (see Chapter 2 for the required components of a Child Health Check-Up). Medicaid reimburses on an all-inclusive fee basis for a Child Health Check-Up, except for immunizations and laboratory services.All providers may be reimbursed for immunization services, in addition to a ChildHealth Check-Up. Certain providers may also be reimbursed for blood leadtesting and other laboratory services. Reimbursement for immunizations andlaboratory services is described as follows.3-4 October 2003