EPSDT Reimbursement Policy for Medicaid Managed Care

This document is a reimbursement policy guide for Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services under Anthem Blue Cross and Blue Shield Healthcare Solutions' Medicaid Managed Care program. It outlines the reimbursement framework for various EPSDT services, including preventive medicine Evaluation and Management (E/M) visits and separately reimbursable component services. The policy specifies the requirements for accurate claims submissions, including the use of appropriate coding and billing guidelines. It emphasizes that services must meet authorization and medical necessity guidelines and that claims may be rejected or denied if proper procedures are not followed. Additionally, the document details the necessary items that must be included in provider claims for EPSDT services, such as EPSDT Special Program Indicator and appropriate diagnosis codes. The policy also references periodicity guidelines established by relevant health organizations and mentions the potential for updates based on provider, state, federal, or CMS mandates.