Early and Periodic Screening, Diagnosis and Treatment
Federal law and regulations require states to provide Early and Periodic Screening, Diagnosis and Treatment (EPSDT) services to Medicaid eligible children under the age of 21, the purpose of which is to ascertain physical and mental defects and to provide treatment to correct or ameliorate any defects or chronic conditions found. States are to inform children and their families of the availability of EPSDT services, their benefits, and where and how to obtain them. States are also to provide transportation and scheduling assistance if requested, to assure that the children receive necessary services.

"Screening" means a periodic comprehensive child health assessment, i.e., regularly scheduled examinations and evaluations of the general physical and mental health, growth, development, and nutritional status of infants, children and youth. These screenings are to include a physical examination, vision and hearing testing, age appropriate immunizations, any necessary diagnostic laboratory tests, and a dental examination beginning at least at age 3.

"Diagnosis and Treatment" means further investigation of any conditions noted during a screening and the provision of any medically necessary treatment services, irrespective of their inclusion in the State Plan as a routinely covered service.

States provide EPSDT services in various ways. Some rely on health department operated medical clinics to perform screenings and to make referrals to appropriate health care professionals for diagnosis and treatment. Some states rely on physicians, dentists and other health care practitioners to perform the screenings during well child exams and to diagnose and treat any defects noted. Federal law and regulations are not specific as to the provider(s) that should render EPSDT services, only that the services must be rendered.

States are precluded, by federal law, from requiring a copayment for any EPSDT service for a child under age 18 but may, at their option, impose a copayment for Medically Needy beneficiaries age 18 and older.

By their nature, EPSDT services may be provided by a number of different providers in many settings. As such, there is no specific coverage policy or reimbursement methodology for this service. Instead, the policy and reimbursement methodology applicable to the provider rendering the service would be used. The reader is referred to the tables for Physicians and Dental Services as the primary source of information about reimbursement.