EPSDT Coding Guide
Last update: January 27, 2021
An EPSDT screening is complete when the seven components have been finished. Claims will be paid at the provider’s EPSDT rate only if the appropriate codes and EP modifier (e.g., 25 and 59) are submitted when billing two different codes in one visit. Visit tnaap.org to get more billing codes that are used for a preventive screening visit. The Tennessee American Academy of Pediatrics’ (TNAAP) EPSDT and Coding program provides training and educational resources FREE of charge to help you improve the quality of preventive health screens. TNAAP also offers annual EPSDT and Coding Update trainings that are held regionally. For more information on these resources, please visit tnaap.org/coding.
EPSDT Coding Guide
The Early Periodic Screening, Diagnosis and Treatment (EPSDT) benefit is a program of checkups and treatment and/or referrals for needed services for all TennCare-eligible children, birth through age 20. These services make sure infants, children, teens and young adults receive the health care they need in Tennessee. |
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It is appropriate to bill for more than one screening tool administered during a visit as well as a sick visit and an EPSDT visit on same day. Simply append Modifier 25 to E/M visit.
When reporting the health risk assessment codes, 96160 and 96161, with developmental screening and/or
emotional/behavioral screening, Modifier 59 should be appended to the health risk assessment code.