Early, Periodic Screening, Diagnosis, and Treatment

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.

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

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

• Early Supports for Infants & Toddlers (Early Intervention)
• Home Visiting
• Prenatal, child, and young adult behavioral health services
• Universal Developmental Screening

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.