Early and Periodic Screening, Diagnosis and Treatment (EPSDT)
Early and Periodic Screening, Diagnosis and Treatment (EPSDT) is a federal law that all medically necessary health care services to be provided to Medicaid-eligible children. Even if a service is not covered under the NC Medicaid State Plan, it can be covered for recipients less than 21 years of age if the service is listed at 1905(a) of the Social Security Act and if all EPSDT criteria are met.
When EPSDT is combined with Health Check, Medicaid provides comprehensive health care services for children and youth.
Coverage and Requirements
Services must be ordered by the child's physician or another licensed clinician. Prior approval from the Division of Medical Assistance may be required to verify medical necessity for some services. Covered services:
- Must be medically necessary to correct or ameliorate a defect, physical or mental illness or a condition that is identified through a screening examination
- Must be listed in section 1905(a) of the Social Security Act
- Must not be experimental/investigational, unsafe or considered ineffective
Medical Assistance Operations Section