Arkansas Administrative Code
Agency 016 - DEPARTMENT OF HUMAN SERVICES
Division 06 - Medical Services
Rule 016.06.08-031 - Child Health Services / Early and Periodic Screening, Diagnosis, and Treatment Provider Manual Update Transmittal #103

Arkansas Medicaid beneficiaries entering the Arkansas foster care system are required to receive an intake physical examination within the first seventy two (72) hours. If the EPSDT provider who performs the screening is not the beneficiary's PCP, the intake physical examination should be billed with procedure codes 99381-99385 and modifiers EP and H9 . Billing with these procedure codes and modifiers will allow the claim to be submitted for payment without a referral from the beneficiary's PCP and will alert the system not to count the screen toward the beneficiary's yearly EPSDT periodic complete medical screening limits.

If the EPSDT provider who performs the screen is the beneficiary's PCP, the intake physical exam should be billed with procedure codes 99391-99395 and modifiers EP and H9 . Billing with these procedure codes and modifiers will allow the claim to be submitted for payment and will not count toward the beneficiary's yearly EPSDT periodic complete medical screening limits.

Procedure codes 99381-99385 and 99391-99395, in conjunction with the EP and H9 modifiers, are to be used only for the required intake physical examination for Medicaid beneficiaries in the Arkansas foster care system.

The table below contains procedure codes, the associated modifiers to be used with the individual code, and a description of each EPSDT service.

Other coding information found in the chart:

1 Exempt from PCP referral requirements

2 Covered when specimen is referred to an independent lab

Electronic and paper claims require use of modifiers. When filing paper claims for an EPSDT screening service, the applicable modifier must be entered on the claim form.

See section 212.000 for EPSDT screening terminology.

NOTES