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EPSDT Home Health Services Code Conversion Policy Overview

December 7, 2018

Effective for dates of service on or after January 1, 2019, Early and Periodic Screening, Diagnostic and Treatment (EPSDT) home health services, which are currently billed using HCPCS Level III local codes will require specified CPT Category I and/or HCPCS Level II national codes.

Providers submitting Treatment Authorization Requests (TARs)/electronic TARs (eTARs) or Service Authorization Requests (SARs)/electronic SARs (eSARs) with dates of service on or after January 1, 2019, must include the appropriate HIPAA-compliant billing codes described in the EPSDT Home Health Code Conversion Crosswalk published September 2018.

Providers should review their inventory for previously approved TARs/eTARs and SARs/eSARs with EPSDT home health services that have dates of services on or after January 1, 2019. Those TARs/eTARs and SARs/eSARs may be submitted with HCPCS Level III local codes until the end-date of that TAR/eTAR or SAR/eSAR.

If a TAR/eTAR or SAR/eSAR is submitted for the purpose of updating codes in the same authorization period, it will not be reviewed for medical necessity.

Provider Resources
Providers should refer to the EPSDT Services: Home Health section of the HIPAA: Code Conversions web page for a complete list of EPSDT home health resources.