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

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Child Health Check-Up Coverage and Limitations HandbookReimbursement Information, continuedBlood Lead TestReimbursementEffective for Datesof Servicebeginning October16, 2003In addition to a Child Health Check-Up, certain providers may be reimbursed forblood lead testing through their provider-specific Medicaid programs, such asphysician services. The provider-specific Medicaid program must allowreimbursement for blood lead testing.The provider may be reimbursed for a blood lead test by using procedure code83655 for a venous or for capillary specimens.The provider may bill for blood lead testing on the CMS-1500 claim form inaddition to a Child Health Check-Up service.County health departments and federally qualified health centers may not bereimbursed for blood lead testing in addition to their encounter rate for a ChildHealth Check-Up.Please refer to the Independent Laboratory Services Coverage and LimitationsHandbook for further information.Providers WhoCannot PerformLaboratory TestsProviders who cannot perform laboratory tests may refer children to a Medicaidparticipating independent laboratory to have the sample or specimen drawn andanalyzed. The independent laboratory can bill Medicaid. Please instruct thelaboratory to enter “Child Health Check-Up related” by checking the EPSDT boxin item 24H on the CMS-1500 claim form.Child HealthCheck-Up by anARNP, PA, orLicensed MidwifeChild Health Check-Ups that are performed by advanced registered nursepractitioners (ARNPs), physician assistants (PAs), and licensed midwives arereimbursed at 80 percent. The ARNP’s, PA’s, or licensed midwife’s providernumber must be entered as the treating provider in item 24K on the CMS-1500claim form for paper claims.Note: See the Florida Medicaid Provider Reimbursement Handbook, CMS-1500for instructions on completing the claim form for paper claims. For electronicclaim submission, contact the Medicaid fiscal agent EDI help desk at 800-829-0218.3-6 October 2003
Child Health Check-Up Coverage and Limitations HandbookAPPENDIX ACHILD HEALTH CHECK-UPPROVIDER TYPES AND MAXIMUM FEESProvider Type and Maximum FeeProvider TypesThe maximum fee varies by provider type. Child Health Check-Up reimbursementis the same for each of the ten CPT Preventive Medicine Services Codes listed(99381-99385EP and 99391-99395EP) in Chapter 3, of this Handbook.Provider TypesMaximum FeeEffective For Datesof Service March 1,2003PhysicianAdvanced Registered Nurse PractitionerPhysician AssistantLicensed MidwifeBirthing CentersCounty Health Department, Federally QualifiedHealth Center, and Rural Health Clinic$71.47$57.17$57.17$52.87$66.09Clinic-specific encounter rateOctober 2003 A-1
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Child Health Check-Up (formerly EPSDT) - Herman & Associates ...

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