Health Management

EPSDT exam  

The Early Periodic Screening, Diagnosis and Treatment (EPSDT) exam is a federally required series of exams for Medicaid recipients through age 20. 

All children of these ages who are CareSource members should receive EPSDT exams. The program is designed to provide comprehensive preventive health care services at regular intervals. The EPSDT exam stresses health education to children and their caretakers in the areas of health maintenance, early intervention, and systematic treatment of problems. 

Well child/EPSDT components

The screening component of the well child checkup includes a general health screening most commonly known as periodic well child exam. The required Well Child/EPSDT screening guidelines based on the American Academy of Pediatrics' recommendations for preventive pediatric health care include:

• Comprehensive health and development history
• Developmental/behavioral assessment
• Age appropriate unclothed physical examination
• Height and weight measurements, and age appropriate head circumference
• Blood pressure for children 3 and older
• Immunization review and administration of appropriate immunizations
• Health education including anticipatory guidance
• Nutritional assessment
• Hearing, vision and dental assessment
• Blood lead level testing for children under 6 years of age
• Interpretive conference and appropriate counseling for parents or guardians
• Objective testing for developmental behavior, hearing and vision must be performed in accordance with the Medicaid periodicity schedule
• Laboratory services for tuberculin, hematocrit, hemoglobin, urinalysis, or other needed testing as determined by the physician must be provided

Exam frequency

The recommended schedule for EPSDT exams is as follows:

• Birth
• 1 month
• 2 months
• 4 months
• 6 months
• 9 months
• 12 months
• 15 months
• 18 months
• 24 months
• Annually from ages 3 through 20

To assist you, CareSource accepts EPSDT forms developed by the Michigan State University Institute for Health Care Studies. You can access these forms under Health Care Links.

EPSDT codes

When submitting claims for EPSDT exams, please use the following age-specific CPT codes: 

New Patient/Initial Exam

Established Patient/Periodic Exam

For more information, please see the Provider Manual.

Lead screening

All children between the ages of 6 and 72 months of age should be screened for lead. Screening is completed by a verbal risk assessment at each EPSDT visit between 6 and 72 months.

Children who are high risk (that is, anyone answering yes to one question on the verbal assessment) will receive a blood lead test at the same visit. Children who are low risk will receive a blood lead test at 12 months, and a second blood test at 24 months.

For more information, please contact the Childhood Lead Poisoning Prevention Program at (517) 335-8885.

Filter-paper testing

Filter paper testing is an accepted method for obtaining blood lead levels and is covered by CareSource.

The filter paper method offers fast, quantitative results from two drops of blood obtained through a fingerstick capillary puncture. It is less invasive than collecting a venous blood sample and can be conveniently performed in a physician's office.

Supplies and instructions are provided by MedTox, the lab that processes the results. Supplies are provided at no charge and lab results are delivered within 24-48 hours of receipt.

Please bill for the capillary stick with CPT code 36416.

For more information, please call MedTox at 1-877-628-7281 or contact your Provider Relations representative.

Immunizations

 

Immunizations are an important part of preventive care for children and should be administered during EPSDT exams, as needed. 

CareSource endorses the recommended childhood immunization schedule approved by the Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics (AAP), and the American Academy of Family Physicians (AAFP).

This schedule is updated annually, and the most current updates can be found at:
www.cispimmunize.org.

Vaccines for children

The federal Vaccines for Children (VFC) program makes vaccines available at no cost to health care Providers for administration to children 18 and younger who are enrolled in Medicaid. 

Currently the VFC program offers free vaccines against the following diseases:

• Diphtheria
• Hemophilus influenza type B
• Hepatitis B
• Measles
• Mumps
• Rubella
• Pertussis
• Poliomyelitis
• Tetanus
• Varicella
• Pneumoccocal disease

Providers may obtain these vaccines by becoming a VFC provider. You will receive the vaccine from the VFC program free of charge, and CareSource will reimburse you for administrative costs. 

For more information, please contact your local health department. 

Michigan Childhood Immunization Registry (MCIR)

The Michigan Childhood Immunization Registry (MCIR) is an online statewide childhood immunization registry operated by the Michigan Department of Community Health. CareSource requires all providers to report each immunization they give to the registry. 

MCIR was developed to provide a single, secure database for information about the immunizations a child has received. Since its creation, the registry has grown to include more than 3 million children and records of more than 35 million vaccinations. 

Providers can use the MCIR database to:

• Look up a child's immunization history
• Update a child's immunization history
• Update a child's demographic information
• Print immunization histories
• Produce administrative reports

For more information, please see the Provider Manual.