EPSDT (Early and Periodic Screening, Diagnostic and Treatment)

What are EPSDT/Child Health Check-Up Visits?

AmeriHealth Caritas Florida primary care providers (PCPs) and pediatricians are responsible for providing Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services, or Child Health Check-Up Visits, to members from birth to age 21, according to the Florida Medicaid EPSDT periodicity schedule (PDF) or upon request at other times, in order to determine the existence of a physical or mental condition.

Children ages 0 to 2 years should visit their physician at ages 1, 2, 4, 6, 9, 12, 15, 18, 24, and 30 months. Children, teens, and young adults ages 3 to 20 years should visit their physician once a year.

Many important items that should be addressed include:

  • Checking normal height, weight, and head growth
  • Assisting mothers with breastfeeding and other feeding/nutrition concerns
  • Screening mothers for postpartum depression symptoms
  • Checking for proper vision, speech, and hearing development
  • Checking the teeth and making needed dental referrals
  • Checking blood count, lead level, and possibly tuberculosis (TB) screening
  • Giving vaccinations for diphtheria, tetanus, pertussis, polio, measles, mumps, rubella, influenza, hepatitis A and B, and chickenpox

Please refer to the American Academy of Pediatrics periodicity schedule for specific guidance.

What is required of providers?

Required screenings

For the initial examination and assessment of a child, PCPs are required to perform:

  • All relevant child health check-up visits, screenings, and services, according to the periodicity schedule (including autism screenings for children ages 18 months and 24 months); and
  • Any additional assessments, using the appropriate tools, to determine whether a child has special health care needs. If assistance is needed for locating a specialty provider or to report determinations, please call the Rapid Response and Outreach team and “Let Us Know” at 1-855-371-8072.
  • And/or please fax this Member Intervention Request Form (PDF) to 1-855-236-9281.
  • For guidance on completing this form, or to inquire about a submission, please call us at, 1-855-371-8072.

Screening time frames

Florida Medicaid providers are contractually obligated to provide Child Health Check-Up Visit screenings.

Age Time frame
Younger than age 2 Within 30 days of the scheduled due date
Age 2 and older Within 60 days of the scheduled due date
Other pediatric members Initial EPSDT/Child Health Check-Up Visit screenings must be offered within 60 days of becoming a plan member

Member education on EPSDT

AmeriHealth Caritas Florida providers are expected to provide written and verbal explanation of EPSDT services to plan members and caregivers including pregnant patients, parent(s) and/or guardian(s), child custodians, and sui juris teenagers. This explanation of EPSDT services should occur on the member's first visit with the provider and must include distribution of appropriate EPSDT educational tools and materials.

Please visit Bright Futures Toolkit for a complete list of resources and handouts.

EPSDT billing guidelines:

Please refer to the full EPSDT Quick Reference Guide (PDF)

EPSDT (Early and Periodic Screening, Diagnostic and Treatment) referral codes

Providers who submit paper claims must complete field 24H (EPSDT Family Plan) on the CMS1500 claim form.

  • AV: Available — not used (recipient refused referral)
  • NU: Not used (no EPSDT recipient referral given)
  • S2: Under treatment (recipient currently under treatment for referred diagnostic or corrective health problem)
  • ST: New service requested (recipient referred to another provider for diagnostic or corrective treatment or scheduled for another appointment with screening provider for diagnostic or corrective treatment for at least one health problem identified during an initial or periodic screening service, not including dental referrals)

Electronic claims

Providers who bill electronically using the 837P format must select the appropriate response for ASC X12N 837: Loop 2300 element CRC02 — "Was an EPSDT referral given to the patient? (Yes or No)" — and provide the appropriate condition indicator in element CRC03 of the electronic claims file. Providers should also submit a value of “Y” in Loop 2400 segment SV111. 

For assistance with electronic billing of EPSDT claims, click here (PDF).

For more information regarding EPSDT/Child Health Check-Up Visits, please call Provider Services at 1-800-617-5727.

EPSDT Guidelines

EPSDT Resources

Vaccines for Children (VFC) Program

Primary care providers and pediatricians treating members up to age 18 must participate in the Vaccines for Children (VFC) Program.

The Florida Department of Health's Vaccines for Children program provides vaccines to children 0 through 18 years of age who meet program eligibility at no cost to the parent/guardian. It supports the Immunization Section's commitment to vaccinate all children. This valuable program allows providers to make routine immunizations available to eligible children without out-of-pocket expenses to the parent/guardian. Contact the Florida Department of Health: 1-877-888-7468.

HPV/Cancer Resources

Providers