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MedicaidAdministrativeMedium impact

MAB2022091902

Pennsylvania Medicaid (DHS)·PA · Pediatrics, Family Medicine, General Practice·Provider Bulletin
Effective date
Sep 19, 2022
We identified it
Jun 20, 2026
Days to comply

Summary

Pennsylvania updated its EPSDT (Early and Periodic Screening, Diagnosis and Treatment) periodicity schedule effective September 19, 2022, with new screening requirements including hepatitis B risk assessment and cardiac risk screening for ages 11-21. The terminology for behavioral screening changed and several footnotes were updated to clarify billing and referral requirements.

Action Required

Action needed
Immediately: Billing teams serving Pennsylvania Medicaid EPSDT patients must update encounter forms and billing systems to reflect the new periodicity schedule. Update terminology from 'Psychosocial/Behavioral Assessment' to 'Behavioral/Social/Emotional Screening' in documentation. Add hepatitis B risk assessment (once between newborn-21 years) and cardiac risk assessment (once between ages 11-21) to appropriate age visit templates. Review updated footnotes for dental referral requirements and depression screening guidelines.

Affected Billing Codes

99460
99463
99381
99382
99391
99392
99383
99384
96161
96110
99173
99174
99177
92551
92552
85013
85018
83655