August 7, 2024
As of July 1, 2024, we’re offering enhanced reimbursement payments to School-Based Health Centers for Early and Periodic Screening, Diagnostic and Treatment services. EPSDT services ensure children enrolled in Medicaid receive timely and appropriate health care, which can lead to early detection and treatment of health issues. This is important in school settings where children may not have regular access to health care providers outside of school.
This reimbursement increase (6% for visits or 20% for screenings) applies to EPSDT services billed using the Current Procedural Terminology (CPT®) codes listed here.
Submitting Claims with Place of Treatment (03) School
SBHC providers who submit claims with EPSDT screening and visit codes on a CMS 1500 with Place of Service code 03-School-Place of Treatment will receive the enhanced reimbursement rate.
See the EPSDT Clinical Practice and Billing Guide for additional information on codes. This comprehensive guide also provides information on EPSDT services, screenings and visits.
Tips for EPSDT Compliance
- Training: Ensure all health care providers and staff at SBHCs are trained on Medicaid’s EPSDT guidelines and stay up to date on changes.
- Documentation: Maintain accurate and detailed records of all EPSDT screenings, follow-up care and referrals. Proper documentation is important for reimbursement and quality improvement efforts. SBHCs can easily submit referral requests and seek assistance from our Care Coordination team through CSS@bcbsnm.com.
- Outreach: Educate students and their families about the importance of regular screenings and preventive care. Use school communication channels to promote EPSDT services.
If you have any questions about EPSDT services or enhanced payment reimbursement, reach out to the Quality Improvement Department at qualityinquiry@bcbsnm.com.
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