Early and Periodic Screening, Diagnosis and Treatment (EPSDT)

Program Overview

The Early Periodic Screening, Diagnosis and Treatment (EPSDT) program combines screening, diagnostic and treatment services to Medicaid-eligible individuals from birth to age 21. These services give children early access to preventive and comprehensive health care to help prevent disease and/or detect disabilities in their early stages, when they are more effectively treated.

References:

AAP “Bright Futures” Recommendations and Content of Complete Encounters for Periodic Screening

• Bright Futures Periodicity Schedule

EPSDT Overview

• UnitedHealthcare Care Provider Manual (Chapter 5, Pages 57 - 61 only)
• North Carolina DHHS EPSDT
• North Carolina DHHS Medicaid Benefit for Children and Adolescents Under Age 21
  

Medical Necessity Requirements of Federal EPSDT Law, Including Details of Meeting EPSDT Criteria, When Submitting Prior Approval Requests

• The Pediatric Medical Necessity Review and EPSDT Guarantee
• Listing of EPSDT Services found at 42 U.S.C. § 1396d(a) [1905(a) of the Social Security Act
• EPSDT Policy Instructions
  

Dental Education and Outreach

• North Carolina DHHS Into the Mouths of Babes​
• North Carolina Division of Medical Assistance Oral Health Periodicity Schedule
• North Carolina Medicaid Dental Services
  

Behavioral Health and Developmental Screening

        Behavioral Health Screenings

• UnitedHealthcare Care Provider Manual​ (Chapter 7, Pages 65 - 67 only)
• Optum - Behavioral Health Toolkit for Medical Providers
• Bright Futures Implementation Tip Sheet - Promoting Mental Health

        Developmental Screenings

• Bright Futures Tool & Resource Kit

Early Intervention, Care Coordination, and other State and Community Services

• North Carolina Early Childhood Action Plan (Pages 15 - 17 Preventive Health Services)
• Provider Playbook 2019 North Carolina Medicaid - Early Intervention Services in Medicaid Managed Care
• North Carolina DHHS Early Intervention