Mercy Care DCS CHP - EPSDT Requirements
Applicable To: Mercy Care DCS CHP
All children under Mercy Care DCS CHP must receive an EPSDT exam within 30 days of removal. This is a contractual requirement from the Department of Child Safety (DCS). Based on recent review, it appears many offices are not coding for EPSDT visits appropriately or submitting their EPSDT forms timely. We would like to reiterate the process.
When a provider sees these members they MUST use appropriate EPSDT codes and not just E&M CPT Codes or or HCPCS Code T1015 for Physical and Dental exams. Even if the member recently had an EPSDT visit and is not due for another visit, an EPSDT Physical and Dental exam must be completed within 30 days of removal. In addition, all immunizations must be up to date and the EPSDT forms must be submitted timely. Timely submission of the EPSDT forms allows us to get a member scheduled with specialty follow-up care, if needed, within 60 days (as contractually required).
For more information regarding EPSDT and appropriate coding, please review the following links:
Mercy Care DCS CHP is carefully monitoring for full compliance and will alert you to further updates.
We appreciate your continued assistance, support and cooperation!
