MedicaidCoverageHigh impact
c 201845
Pennsylvania Medicaid (DHS)·PA · Pediatrics, Family Medicine·Provider Bulletin
Effective date
Aug 10, 2015
We identified it
Jun 20, 2026
Summary
Pennsylvania has updated its Medicaid EPSDT (Early and Periodic Screening, Diagnosis and Treatment) program requirements for pediatric preventive care screenings, adding new mandatory screenings for congenital heart defects, depression, HIV risk assessment, and cholesterol while removing routine cervical cancer screening for patients under 21. The changes also modify vision and hearing screening frequencies to align with American Academy of Pediatrics recommendations.
Action Required
Immediately: Billing teams for pediatric providers in Pennsylvania must update EPSDT screening protocols and billing systems to include new mandatory screenings: pulse oximetry for newborn congenital heart defect screening, depression screening for ages 11-20, cholesterol screening for ages 9-11, and HIV risk assessment for ages 16-18. Remove routine cervical cancer screening for patients under 21. Update encounter forms and EMR templates to reflect revised vision screening requirements (required at ages 3,4,5,6,8,10,12,15,18 only) and hearing screening requirements (required at ages 4,5,6,8,10 only). Ensure all age-specific screening requirements match the updated periodicity schedule to avoid claim denials for incomplete EPSDT screens.