EPSDT Pediatric Screening Tools

 

The South Carolina Department of Health and Human Services (SCDHHS) is expanding the availability of behavioral health pediatric screening tools and providing guidance on the utilization of these tools.  Best practice indicates that standardized screenings of this type are recommended to be done during the Early Periodic Screening, Diagnosis, and Treatment (EPSDT) visits or as dictated by clinical need.  This recommendation is in alignment with the American Academy of Pediatrics (AAP) recommendations regarding screening and surveillance of family and social environment for risk factors and mental health screening of children and adolescents in primary care settings.

Effective January 1, 2013, SCDHHS updated its policy to cover Current Procedural Terminology (CPT) Codes:

  • 99420 - Administration of health risk assessment instrument (e.g., health hazard appraisal)  
  • 96110 - Developmental screening with interpretation per standardized instrument

SCDHHS will allow physicians to bill CPT code 99420 up to three (3) times during zero (0) to eleven (11) months of the child’s life and one time per year for ages one (1) through five (5).  The code can be used for a standardized screening tool to assess for trauma exposure and/or to update the child and family’s psychosocial history.  Standardized screening tools can be used to assess for such issues as postpartum depression, parental distress, domestic violence, parental substance abuse or mental illness, youth and family social support, grief, and loss.  Tools include, but are not limited to, the Edinburgh Maternal Depression Screen and the Safe Environment for Every Kid – Parent Screening Questionnaire.  CPT code 99420 must include the child’s Medicaid ID number.  Documentation must include a copy of the completed screen with the score along with interpretation and outcome of the screening tool. 

CPT code 96110 is used to cover standardized developmental, mental, emotional, and behavioral screening instruments.  A general screen is recommended with follow up screens as indicated.  This code is limited to a frequency of five (5) times per date of service for ages up to 18 years of age.  Documentation must include a copy of the completed screen with the score along with interpretation and outcome of the screening tool. 

Covered standardized screening instruments for CPT code 96110 include, but are not limited to:

  • Ages and Stages, 3rd Edition (ASQ),
  • Parents Evaluation of Developmental Status (PEDS),
  • Modified Checklist of Autism in Toddlers (MCHAT),
  • Pediatric Symptom Checklist (PSC) or Pediatric Symptom Checklist – Youth Report (PSC-Y),
  • CRAFFT substance use screen (acronym for Car, Relax, Alone, Forget, Friends, Trouble),
  • Modified Patient Health Questionnaire (PHQ-9),
  • Self-report for Childhood Anxiety Related Emotional Disorders (SCARED); and
  • Vanderbilt Diagnostic Rating Scale (Vanderbilt).

The table below outlines reimbursement for these services.

2013 Codes

Description

Unit/Frequency

Rates

 

99420

administration of health risk assessment instrument (eg., health hazard appraisal)

3 x during first 11 months of a child’s life;

1x per year for children aged 1-5 years old

$8.14

 

96110

developmental screening with interpretation per standardized instrument

Up to 5 times per date of service for ages up to 18 years of age

$7.11

 

This bulletin applies to Fee-For-Service and Medical Homes Networks (MHNs).  If you have any questions regarding this bulletin, please contact the SC Provider Service Center at (1-888-289-0709).  Thank you for your continued support of the South Carolina Medicaid Program.

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