EPSDT Screenings and Tests for Children and Young Adults (Ages 1–20)
Date: 09/24/25
What Is EPSDT?
Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) is a Medicaid benefit that covers periodic screenings to determine healthcare needs for children. EPSDT is key in ensuring that all Medicaid-eligible children receive healthcare services such as comprehensive screening, diagnostic treatment, and preventive care for children 20 years of age and younger. These visits should consist of the following:
| Early | Assessing and identifying problems early, beginning at birth |
|---|---|
| Periodic | Age-appropriate child screenings/services at periodic time intervals |
| Screening | Providing physical, developmental, mental, hearing, vision, and dental screenings |
| Diagnosis | Performing diagnostic services and testing and follow-up when risk(s) are identified |
| Treatment | Controlling, correcting, or ameliorating health problems when found |
Why Is EPSDT Important?
Children covered by Medicaid are more likely to be born with:
- Low birth weight
- Poor health
- Developmental delays or learning disorders
- Medical conditions, such as asthma, requiring ongoing use of prescription drugs
It is important that children and adolescents get all the recommended preventive services and any medical treatment necessary to promote healthy growth and development. EPSDT emphasizes prevention, which can help ensure the early identification, diagnosis, and treatment of conditions before they become more complex and costly to treat.
Recommended EPSDT Schedule:
All members should have visits based on recommended timelines. All new members should be scheduled within 60 days of enrollment. Complete visits at the following ages listed below:
| • 3–5 days | • 4 months | • 12 months | • 24 months |
| • 1 month | • 6 months | • 15 months | • 30 months |
| • 2 months | • 9 months | • 18 months | • 3–21 years |
Early Periodic Screenings:
| CPT® | New Patient | CPT® | Established Patient |
|---|---|---|---|
| 99381 | Preventive visit, age <1 year | 99391 | Preventive visit, age <1 year |
| 99382 | Preventive visit, ages 1–4 | 99392 | Preventive visit, ages 1–4 |
| 99383 | Preventive visit, ages 5–11 | 99393 | Preventive visit, ages 5–11 |
| 99384 | Preventive visit, ages 12–17 | 99394 | Preventive visit, ages 12–17 |
| 99385 | Preventive visit, ages 18–20 | 99395 | Preventive visit, ages 18–20 |
| CPT® | Description |
| 97802-97803 | Medical nutrition therapy |
Early Periodic Screenings Modifier:
An EP modifier is used to identify early and periodic screenings.
- Services provided during these screenings should have an EP modifier included. It’s important to append an EP modifier to these services. This also includes adults.
- For vaccines: Always append the EP modifier to all vaccine codes.
HEDIS® Measures That Can Be Met With an EPSDT Visit:
- Child and Adolescent Well-Care Visits (W30 and WCV)
- Child Immunization Status (CIS – Combo 10)
- Immunizations for Adolescents (IMA – Combo 2)
- Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents (WCC)
- Lead Screening in Children (LSC)
- Chlamydia Screening in Women (CHL)
- Annual Dental Visits for Children and Adolescents (ADV)
- Follow-Up for Children Prescribed ADHD Medication (ADD-E)
- Use of First-Line Psychosocial Care for Children and Adolescents antipsychotics (APP)
- Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM-E)
Best Practice Tips:
- To help ensure the best outcomes, providers should:
- Give written notice of appointments, contact parents/guardians, and make sure children receive all necessary services.
- Send appointment reminders to give members written notice of appointment dates and/or notify members by phone.
- Use the Secure Provider Portal to identify individuals who are due and overdue for EPSDT services and contact members to be seen.
Staff should reach out to:
- Parents/guardians of members under 18 AND members ages 18–20 who need follow-up care.
- Pregnant or postpartum members under 18 who need prenatal or postpartum care.
Ensure that children receive these necessary services:
- Outreach and screening
- All medical, vision, hearing, and dental services/screenings
- Appropriate immunizations
- Laboratory tests, including lead toxicity screening
- Comprehensive health and developmental history
- A comprehensive unclothed physical exam
- Health education, including counseling for issues and risk factors, while also informing members about the benefits of a healthy lifestyle, safety practices/accident avoidance, and disease prevention.
NOTE: The information listed here is not all-inclusive and should be used as a reference only. Please refer to current ICD-10/CPT®/HCPCS coding and documentation guidelines found at cms.gov. HEDIS® measures can be found at ncqa.org.