MedicaidBilling CodesMedium impact
Clarification of Medicaid Coverage and Billing of the Initial Health Screening for Children Entering State-Supervised Care
Maryland Medicaid·MD · Pediatrics, Family Medicine, General Practice·Provider Transmittal
Effective date
Mar 25, 2024
We identified it
Jun 20, 2026
Summary
Maryland Medicaid clarifies billing procedures for initial health screenings of children entering state-supervised care. Providers must use modifier 32 with specific preventive medicine CPT codes (99381-99385 for new patients, 99391-99395 for established patients) to receive payment and allow these codes to be billed multiple times per calendar year for eligible children. This distinction separates initial screenings from traditional comprehensive EPSDT visits.
Action Required
Effective immediately: Billing team must update billing software to automatically append modifier 32 when coding initial health screenings for children entering state-supervised care using CPT codes 99381-99385 (new patients) or 99391-99395 (established patients). Configure system to allow these codes to be billed multiple times per calendar year when modifier 32 is present, distinguishing them from standard EPSDT visits. Ensure modifier 32 is ONLY used for the initial screening visit, not subsequent visits. Update all provider encounter forms and billing templates to include education on proper modifier 32 usage. Providers must verify MCO enrollment and eligibility using EVS/IVR (1-866-710-1447) or WebEVS before billing. Failure to use modifier 32 correctly will delay payment and may result in claim denials or recoupment.