MEDICAID HCY SCREENINGS (EPSDT)
EXAM	CPT Code(s)	Description	Modifier(s)	ICD-9-CM Code(s)
Full Medical Screening
New Patient	99381	Initial preventive medicine new patient under age 1	21, EP	V20.2 - Routine infant or child health check
	99382	Initial preventive medicine new patient 1yr-4yr	21, EP	V20.2 - Routine infant or child health check
	99383	Initial preventive medicine new patient 5yr-11yr	21, EP	V20.2 - Routine infant or child health check
	99384	Initial preventive medicine new patient 12yr-17yr	21, EP	V20.2 - Routine infant or child health check
	99385	Initial preventive medicine new patient 18yr	21, EP	V20.2 - Routine infant or child health check
Established Patient	99391	Periodic preventive medicine age under 1	21, EP	V20.2 - Routine infant or child health check
	99392	Periodic preventive medicine 1yr-4yr	21, EP	V20.2 - Routine infant or child health check
	99393	Periodic preventive medicine 5yr-11yr	21, EP	V20.2 - Routine infant or child health check
	99394	Periodic preventive medicine 12yr-17yr	21, EP	V20.2 - Routine infant or child health check
	99395	Periodic preventive medicine 18yr	21, EP	V20.2 - Routine infant or child health check
Unclothed Physical
and History
New Patient	99381	Initial preventive medicine new patient under age 1	EP	V20.2 - Routine infant or child health check
	99382	Initial preventive medicine new patient 1yr-4yr	EP	V20.2 - Routine infant or child health check
	99383	Initial preventive medicine new patient 5yr-11yr	EP	V20.2 - Routine infant or child health check
	99384	Initial preventive medicine new patient 12yr-17yr	EP	V20.2 - Routine infant or child health check
	99385	Initial preventive medicine new patient 18yr	EP	V20.2 - Routine infant or child health check
Established Patient	99391	Periodic preventive medicine age under 1	EP	V20.2 - Routine infant or child health check
	99392	Periodic preventive medicine 1yr-4yr	EP	V20.2 - Routine infant or child health check
	99393	Periodic preventive medicine 5yr-11yr	EP	V20.2 - Routine infant or child health check
	99394	Periodic preventive medicine 12yr-17yr	EP	V20.2 - Routine infant or child health check
	99395	Periodic preventive medicine 18yr	EP	V20.2 - Routine infant or child health check
Reduced Preventative
Screening
New Patient	99381	Initial preventive medicine new patient under age 1	52, EP	V20.2 - Routine infant or child health check
	99382	Initial preventive medicine new patient 1yr-4yr	52, EP	V20.2 - Routine infant or child health check
	99383	Initial preventive medicine new patient 5yr-11yr	52, EP	V20.2 - Routine infant or child health check
	99384	Initial preventive medicine new patient 12yr-17yr	52, EP	V20.2 - Routine infant or child health check
	99385	Initial preventive medicine new patient 18yr	52, EP	V20.2 - Routine infant or child health check
Established Patient	99391	Periodic preventive medicine age under 1	52, EP	V20.2 - Routine infant or child health check
	99392	Periodic preventive medicine 1yr-4yr	52, EP	V20.2 - Routine infant or child health check
	99393	Periodic preventive medicine 5yr-11yr	52, EP	V20.2 - Routine infant or child health check
	99394	Periodic preventive medicine 12yr-17yr	52, EP	V20.2 - Routine infant or child health check
	99395	Periodic preventive medicine 18yr	52, EP	V20.2 - Routine infant or child health check
Partial Screening
HCY Dental Screening	99429	Unlisted preventive medicine service		V20.2 - Routine infant or child health check
Dev/Mental Health Screening	99429	Unlisted preventive medicine service	59	V20.2 - Routine infant or child health check
HCY Hearing Screening	99429	Unlisted preventive medicine service	EP	V20.2 - Routine infant or child health check
Vision Screening	99429	Unlisted preventive medicine service	52	V20.2 - Routine infant or child health check
June 12, 2003 Volume 25 #1
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