Early, Periodic Screening, Diagnosis, and Treatment

Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) is a federally mandated, comprehensive, and preventive pediatric health care benefit. The purpose of this program is to ensure children and adolescents age birth up to 21 receive appropriate preventive, dental, mental health, developmental, and specialty services. Apple Health covers an array of policies and programs supporting pediatric health, in alignment with EPSDT.

This page helps Apple Health providers and partners stay informed about the EPSDT program.

What is EPSDT?

EPSDT is a comprehensive and preventive health care benefit for Apple Health clients under the age of 21 years old. The EPSDT benefit requires periodic screening services, often referred to as well-child checkups, as one of the mandatory components to monitor healthy development and identify issues as early as possible. Medically necessary services, including those identified through well-child checkups, are covered under the EPSDT benefit.

Learn more about EPSDT at Medicaid.gov.

How are requests evaluated?

HCA evaluates requests for medical necessity based on the definition in WAC 182-500-0070 and the process in WAC 182-501- 0165.

What are the components of the EPSDT benefit?

  • Early: Monitor healthy development to identify problems early
  • Periodic: Provide well-child checkups at established, age-appropriate intervals
  • Screening: Conduct physical, dental, mental, developmental, hearing, vision, and other screening or laboratory tests to detect potential issues
  • Diagnosis: Diagnostic assessment and testing to follow-up when a risk is identified during checkups and screening
  • Treatment: Medically necessary health care services to control, correct, or ameliorate any identified issues regardless of whether the service is covered in the state Medicaid plan

Noncovered services

To request a noncovered service, send a completed Fax/Written Request Basic Information form (HCA 13-756) to the address or fax listed on the form.

EPSDT resources

Bright Futures

HCA policies for EPSDT align with the American Academy of Pediatrics (AAP) Bright Futures recommendations. Bright Futures is AAP’s national initiative offering evidence-driven guidance for pediatric preventive health care. Access materials, tools, and recommendations at AAP’s Bright Futures.

Pediatric services and programs

Well-child checkup billing

HCA updates provider billing guides quarterly, as needed. Providers may access the most up-to-date version of the EPSDT well-child program billing guide on the Provider billing guides and fee schedules webpage.

EPSDT updates

HCA wants to make sure you’re informed about our EPSDT work. Subscribe to the Pediatric Health mailing list to get the latest bulletin updates.

Recent bulletins are linked below.