The purpose of this transmittal is to notify EPSDT/HealthCheck providers about new rates and billing requirements for well-child visits, and changes to the EPSDT Billing Manual and DC HealthCheck Periodicity Schedule.

All Medicaid-eligible children should receive the comprehensive child health benefit for infividuals under the age of 21 known as the Early and Periodic Screening, Dianostic, and Treatment (EPSDT) services benefit. In the District, EPSDT is often referred to as “HealthCheck.” The Department of Health Care Finance (DHCF) is the District agency responsible for administering the Medicaid program, including the EPSDAT/HealthCheck benefit. A core component of the EPSDT Benefit requires periodic well-child visits, which should be done in accordance with the attached DC HealthCheck Periodicity Schedule (available at DHCF has made changes to how the core well-child visit and each of the interventions the child received at that visit should be billed.

On October 1, 2014 the new billing requirements with a rate adjustment for fee-for-service pediatric primary care providers will go into effect. The new billing requirements will go into effect on January 1, 2015 for pediatric providers paneled with any of the DC Medicaid Managed Care Organizations. Effective and efficient adherence to the new requirements will allow us to better determine the care that children in our program are receiving and will result in increased revenue to those providers who are delivering all of the required components of care.