EPSDT visits/services, Medicaid
Medicaid, MIChild, Healthy Michigan Plan
Use these codes when reporting early and periodic screening, diagnosis and treatment (EPSDT) "Normal Newborn" or "Well Child" exams of Medicaid patients.
Another resource is the American Academy of Pediatrics' "Bright Futures" website. Scroll down their web page to find the AAP Periodicity Schedule.
New patient visits
99460: History & physical of inpatient "Normal Newborn"
99463: History & physical of newborn for same day discharge
99381: Initial evaluation, under age of 1 year
99382: Initial evaluation, age 1-4 years
99383: Initial evaluation, age 5-11 years
99384: Initial evaluation, age 12-17 years
99385: Initial evaluation, age 18-21
Established patient visits
99391: Reevaluation, under age of 1 year
99392: Reevaluation, age 1-4 years
99393: Reevaluation, age 5-11 years
99394: Reevaluation, age 12-17 years
99395: Reevaluation, age 18-21 years
EPSDT-required services that may be billed separately
When performed according to the periodicity table. For complete descriptions, refer to the Physician's Current Procedural Terminology code book.
81002: Urine testing with standardized reagent dipstick for sugar & albumin
Vaccines & immunizations
See billing codes
86580 or 86585: Tuberculin testing (TB)
90460, 90471, 90473: One vaccine
90472, 90474: Subsequent vaccines; must bill administration code and immunization code, even if immunization serum was free.
96110: Developmental testing, limited (e.g., developmental screening test II, early language milestone screen) with interpretation and report
96111: Developmental testing, extended (includes assessment of motor, language, social, adaptive and/or cognitive functioning by standardized developmental instruments) with interpretation and report