Early Periodic Screening Diagnosis and Treatment Attachment (EPSDT)

If the EPSDT check box is selected in the Insurance Carrier Table AND the procedure code entered is 99381, 99382, 99383, 99384, 99385, 99391, 99392, 99393, 99394, or 99395 AND/OR any code with the EP modifier, it will trigger the EPSDT Attachment.

 

 

Data Field Information
Prompt Response Req Len
EPSDT Referral Given If an EPSDT referral was given, select this check box.

1

Condition 1 Select the condition from the list.   1
Condition 2 Select the condition from the list.   1
Condition 3 Select the condition from the list.   1