EPSDT Pediatric Screening Tools

The South Carolina Department of Health and Human Services (SCDHHS) is clarifying the use of developmental and 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  is in alignment with the American Academy of Pediatrics (AAP) recommendations regarding screening and age appropriate development and mental health of children and adolescents in primary care settings.

Effective January 1, 2015, SCDHHS added Current Procedural Terminology (CPT) code 96127 to break out the services of emotional and behavioral assessments from developmental screening reported with CPT code 96110.

CPT code 96110 is used to report standardized screening to identify childhood and adolescent developmental levels.  A general screen is recommended with follow up screens as indicated.  This code is limited to a frequency of two (2) times per date of service for children up to 18 years of age.  Documentation must include a copy of the completed screen with the score and documentation per instrument 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), and
  • Modified Checklist of Autism in Toddlers (MCHAT).

CPT code 96127 is used to report a standardized instrument to assess the patient’s emotional and/or behavioral health.  A general screen is recommended with follow up screens as indicated.  This code is limited to a frequency of four (4) times per date of service for children up to 18 years of age. Documentation must include a copy of the completed screen along with scoring and documentation per standardized instrument.

 

Covered standardized screening instruments for CPT code 96127 include, but are not limited to:

  • Ages and Stages Questionnaire: Social –Emotional (ASQ:SE)
  • Pediatric Symptom Checklist (PSC) or Pediatric Symptom Checklist – Youth Report (PSC-Y),
  • 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.

2015 Codes

Description

Unit/Frequency

Rates

96110

Developmental screening with scoring and documentation per standardized instrument

Up to 2 times per date of service for ages up to 18 years of age

$7.11

96127

Brief emotional/behavioral assessment with scoring and documentation, per standardized instrument

Up to 4 times per date of service for ages up to 18 years of age

$7.11

 

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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