DHS issued MA Bulletin 99-24-08 Pennsylvania’s Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program Periodicity Schedule and Coding Matrix, effective Oct. 29, 2024. This bulletin applies to all providers enrolled in the Medical Assistance (MA) Program who provide EPSDT screens for MA beneficiaries in the fee-for-service and managed care delivery systems. Providers rendering services in the managed care delivery system should address any payment related questions to the appropriate MA managed care organization. This is in response to CMS published highly anticipated guidance on early and periodic screening, diagnostic, and treatment (EPSDT) benefit. Under the EPSDT requirements at Section 1905(a)(4)(B) and (r) of the Social Security Act, children under age 21 are entitled to Medicaid coverage of Section 1905(a) services that are medically necessary to correct or ameliorate physical or mental conditions, even if these services are not covered under the state plan.
