EPSDT and Coding Overview

Early Periodic Screening, Diagnosis and Treatment (EPSDT) is a program of check-ups and treatment and/or referrals for needed services for all TennCare eligible children birth until age 21. These services make sure babies, children, teens and young adults receive the health care they need. In Tennessee, the EPSDT program is called TennCare Kids.

TNAAP Provides EPSDT and Coding Training and Resources to Help You:

  • Improve the quality of preventive health screens you perform
  • Optimize reimbursement
  • Reduce administrative costs
  • Improve audit outcomes

EPSDT and Coding Program

The EPSDT and Coding Program is funded by a grant from the Bureau of TennCare and carried out by The Tennessee Chapter of the American Academy of Pediatrics (TNAAP).

TNAAP's EPSDT and Coding Program provides training and educational resources FREE of charge to help you improve the quality of preventive health screens you perform and can assist with Pediatric Coding issues for both general and specialty practices through various resources and services. Educational training programs can be provided at individual practices and customized topic-specific sessions are available. TNAAP also offers annual EPSDT and Coding Update Trainings held regionally.

EPSDT – Early Periodic Screening, Diagnosis and Treatment

What is EPSDT?

The Early Periodic Screening, Diagnosis and Treatment (EPSDT) service is Medicaid’s comprehensive and preventive child health program for individuals under the age of 21. EPSDT is designed to improve primary health for children under age 21 with emphasis on preventive care that has been a part of the federal Medicaid program since its beginning in the late 1960s. After a Medicaid review in 1989, Congress moved to increase the services of EPDST through the Omnibus Budget Reconciliation Act of 1989.

States must now cover regular and periodic exams for all eligible children under age 21 and provide any medically necessary services prescribed by the exams, even those not covered in the state’s Medicaid plan. This includes many assistive devices and services for individuals that are under age 21 which have been excluded under the regular Medicaid program in the past.

Federal EPSDT Requirements:

http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Benefits/Early-and-Periodic-Screening-Diagnostic-and-Treatment.html

TennCare Kids

TennCare Kids

Tennessee’s EPSDT program is called TennCare Kids. TennCare Kids is described as a full program of check-ups and health care services for children who have TennCare.

One of the key goals of TennCare Kids is to assure that health problems found are diagnosed and treated early, before they become more complex. The Tennessee Chapter of the American Academy of Pediatrics (TNAAP) supports this goal. Specific services are required at specific ages birth until 21.

For more information about TennCare Kids, visit the TennCare website:

http://www.tennessee.gov/tenncare/section/tenncare-kids

For more information about EPSDT, visit the Medicaid website:

http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Benefits/Early-and-Periodic-Screening-Diagnostic-and-Treatment.html

EPSDT Components

Components of EPSDT/TennCare Kids exams include:

  • Comprehensive Heath and Developmental History
  • Comprehensive Unclothed Physical Exam
  • Vision Screening
  • Hearing Screening
  • Laboratory Tests/Procedures
  • Immunizations
  • Health Education/Anticipatory Guidance

EPSDT and Coding Contact Information

Janet Sutton, CPC, RHIT
AHIMA Approved ICD-10-CM Trainer
Coding Educator
Phone: 615-447-3264
Fax: 615-383-7170
Email: janet.sutton@tnaap.org