Clinical Coverage Policies

  • 4A, Dental Services
  • 4B, Orthodontic Services

1-I, Dietary Evaluation and Counseling and Medical Lactation Services

More information can be found on the main EPSDT web page

  • 2A-1, Acute Inpatient Hospital Services
  • 2A-2, Long Term Care Hospital Services
  • 2A-3, Out-of-State Services
  • 2B-1, Nursing Facilities
  • 2B-2, Geropsychiatric Units in Nursing Facilities
  • 1S-1, Genotyping and Phenotyping for HIV Drug Resistance Testing
  • 1S-2, HIV Tropism Assay
  • 1S-3, Laboratory Services
  • 1S-4, Genetic Testing
  • 1S-8, Drug Testing for Opioid Treatment and Controlled Substance Monitoring
  • 1M-2, Childbirth Education
  • 1M-3, Health and Behavior Intervention
  • 1M-4, Home Visit for Newborn Care and Assessment
  • 1M-5, Home Visit for Postnatal Assessment and Follow-up Care
  • 1M-6, Maternal Care Skilled Nurse Home Visit
  • 5A-1, Physical Rehabilitation Equipment and Supplies
  • 5A-2, Respiratory Equipment and Supplies
  • 5A-3, Nursing Equipment and Supplies
  • 5B, Orthotics & Prosthetics
  • 1E-1, Hysterectomy
  • 1E-2, Therapeutic and Non-therapeutic Abortions
  • 1E-3, Sterilization Procedures
  • 1E-4, Fetal Surveillance
  • 1E-5, Obstetrics
  • 1E-6, Pregnancy Medical Home
  • 1E-7, Family Planning Service