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New EPSDT Provider Manual Section Coming

July 5, 2018

To help providers better understand the scope of services allowable under the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit and to be aware of the differing criteria for medical necessity, a new EPSDT provider manual section is being developed and will be released in a future Medi-Cal Update and CHDP Update.

EPSDT services are a benefit of the Medi-Cal program as specified in Title XIX of the Social Security Act, Section 1905(r)(5) [Title 42 of the United States Code, Section 1396d(r)]. The benefits covered under EPSDT provide comprehensive and preventive health care services for individuals under 21 years of age who are enrolled in Medi-Cal. These services are key to ensuring that children and youth receive appropriate preventive medical, dental, vision, hearing, mental health, substance use disorder, developmental and specialty services, as well as all necessary services to address any defects, illnesses or conditions identified.