Child Health Check-Up (formerly EPSDT) - Herman & Associates ...
Child Health Check-Up (formerly EPSDT) - Herman & Associates ...
Child Health Check-Up (formerly EPSDT) - Herman & Associates ...
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<strong>Child</strong> <strong>Health</strong> <strong>Check</strong>-<strong>Up</strong> Coverage and Limitations HandbookReimbursement Information, continuedImmunizationServicesReimbursementIn addition to a <strong>Child</strong> <strong>Health</strong> <strong>Check</strong>-<strong>Up</strong>, providers may be reimbursed forimmunization services through their provider-specific Medicaid programs, suchas physician services. The provider may bill for immunization services on theCMS-1500 claim form in addition to a <strong>Child</strong> <strong>Health</strong> <strong>Check</strong>-<strong>Up</strong> service.Note: See the service-specific coverage and limitations handbook for informationon reimbursement for immunization services.Tuberculin SkinTestReimbursementIn addition to the <strong>Child</strong> <strong>Health</strong> <strong>Check</strong>-<strong>Up</strong>, providers may be reimbursed fortuberculin skin tests through their provider-specific Medicaid programs, such asphysician services. The provider may bill for the tests on the CMS-1500 claimform in addition to a <strong>Child</strong> <strong>Health</strong> <strong>Check</strong>-<strong>Up</strong> service.Note: See the service-specific coverage and limitations handbook for informationon reimbursement for tuberculin skin tests.Laboratory TestsReimbursementIn addition to a <strong>Child</strong> <strong>Health</strong> <strong>Check</strong>-<strong>Up</strong>, certain providers may be reimbursed forlaboratory testing, including dipstick urine and finger stick hemoglobin andhematocrit, through their provider-specific Medicaid programs, such as physicianservices. The provider-specific Medicaid program must allow reimbursement forlaboratory tests. Medicaid does not reimburse for the collection and handling ofspecimens during a physician’s office visit.To perform laboratory tests and analyze the results, the provider’s officelaboratory must be certified by the Clinical Laboratories ImprovementAmendment of 1988 (CLIA).The provider may bill for laboratory tests on the CMS-1500 claim form in additionto a <strong>Child</strong> <strong>Health</strong> <strong>Check</strong>-<strong>Up</strong> service.County health departments and federally qualified health centers may not bereimbursed for laboratory tests in addition to their encounter rate for a <strong>Child</strong><strong>Health</strong> <strong>Check</strong>-<strong>Up</strong>.October 2003 3-5