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It's important to bill claims with appropriate codes when you are billing preventive or well-child care for Early Periodic Screening and Developmental Testing (EPSDT) services. This information can be reviewed in further details Chapter 3 of our Claims Processing Manual.
As a reminder, key information is as follows:
Children may receive additional inter-periodic screening at the discretion of their provider. MC does not limit the number of well-child visits that members under age 21 may receive. Claims should be billed with the following ICD-10-CM Diagnosis Codes based on age appropriateness:
Codes to Identify Well-Child Visits – Ages 0 – 21 Years
CPT Codes
99381-99385; 99391-99395; 99461
ICD-10-CM Diagnosis Codes
Z00.110, Z00.111, Z00.121, Z00.129, Z02.2, Z02.3, Z276.1, Z276.2
Well Child Visits for sports and other activities should be based on the most recent EPSDT Well Child Visit, as the annual Well Child Visits are comprehensive and should include all of the services required for sports or other activities. AHCCCS does not cover sports or other physicals solely for that purpose. If it can be combined with a regularly scheduled EPSDT visit, it is covered, though no additional payment would be allowable for completing the school or other organization paperwork that would allow the child to participate in the activity.
Please don't hesitate to contact your Mercy Care Network Management Representative with any questions or comments. You can find this Notice and all other provider notices on our Mercy Care website.
Thanks for all you do!
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