MedicaidBilling CodesHigh impact
Updates to the 2017 Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program Periodicity Schedule MAB 99-18-02
Pennsylvania Medicaid (DHS)·PA · Pediatrics, Family Medicine·Provider Bulletin
Effective date
Jan 3, 2018
We identified it
Jun 20, 2026
Summary
Pennsylvania updated its EPSDT program effective January 3, 2018, adding a new 3-5 day newborn periodicity, changing maternal depression screening from CPT 96160 to CPT 96161, adding instrument-based vision screening codes CPT 99174 and CPT 99177, and expanding allowable ICD-10 diagnosis codes for newborn health examinations.
Action Required
Immediately: Update billing system to use CPT 96161 instead of 96160 for maternal depression screens during EPSDT visits. Add CPT 99174 and 99177 for instrument-based vision screening. Include new ICD-10 codes Z00.110, Z00.111, Z38.01, Z38.1, and Z38.3-Z38.8 for newborn examinations. Schedule 3-5 day follow-up visits for newborns after hospital discharge. Use modifier 52 when maternal depression screening cannot be completed.