Welcome to the Department of Health Care Services Welcome to Medi-Cal Welcome to the Department of Health Care Services

EPSDT Program Code Conversion: Policy Overview

July 9, 2018

Effective for dates of service on or after August 27, 2018, HCPCS Level III local Early and Periodic Screening, Diagnosis and Treatment (EPSDT) service codes Z5830 and Z5868 will be terminated and replaced with HIPAA-compliant national HCPCS Level II codes T1029 and T1026 as shown in the crosswalk below. This conversion will also include the use of the EP modifier to indicate EPSDT services.

Local Code – Description National Revenue Codes – Description National Procedure Codes – Description Modifier – Description
Z5830 – Onsite investigation to detect source of lead contamination rendered by local health department or comprehensive environment agencies. 0969 – Professional fees, other T1029 – Comprehensive environmental lead investigation, not including laboratory analysis, per dwelling EP – Service provided as part of a Medicaid early and periodic screening diagnosis and treatment program (EPSDT).
Z5868 – Pediatric day health care   T1026 – Intensive, extended multidisciplinary services provided in a clinic setting to children with complex medical, physical, medical and psychosocial impairments, per hour EP – Service provided as part of a Medicaid early and periodic screening diagnosis and treatment program (EPSDT).

Providers should prepare and submit Treatment Authorization Requests (TARs) and Service Authorization Requests (SARs) according to the instructions below.

TAR Conversion Policy for Previously Approved, Retroactive and Deferred TARs
Beginning August 27, 2018, all TARs with HCPCS Level III local code Z5868, regardless of status (approved, retroactive or deferred), will be invalid and providers will need to end-date for dates of service after August 26, 2018. Providers are encouraged to submit new TARs with the appropriate HCPCS Level II national code(s) for services on or after August 27, 2018.

TARs Submitted on or After August 27, 2018
All TARs and eTARs submitted on or after August 27, 2018, which require authorization beyond this date must include only HCPCS Level II national codes.

Providers are strongly encouraged to use eTARs. Provider benefits when using the eTAR include:

  • No mail delays or postage,
  • Money savings,
  • Quicker response time.

Additionally, eTARs allow providers to check the status of their TAR at any time. For additional information, providers are encouraged to look for an upcoming eTAR seminar in their area.

SAR Conversion Policy
Effective for dates of service on or after August 27, 2018, new SARs for EPSDT services must include HCPCS Level II national codes.

SARs Submitted After August 26, 2018
California Children’s Services (CCS)/Genetically Handicapped Persons Program (GHPP) providers should review their EPSDT service SARs that extend beyond August 26, 2018. For those SARs, providers must submit a new SAR with the appropriate HCPCS Level II national code(s) to cover any remaining service period on or after August 27, 2018.

SARs Previously Authorized with Through Dates After August 26, 2018
Effective for dates of service on or after August 27, 2018, SARs authorized with through dates beyond August 26, 2018, must be end-dated. Additionally, providers should request existing SARs with the HCPCS Level III local codes be end-dated August 26, 2018.

SARs Submitted on or After August 27, 2018
Effective for dates of service on or after August 27, 2018, providers may begin requesting SARs with HCPCS Level II national codes. SARs using the HCPCS Level III local codes may be submitted only for dates of service ending before August 27, 2018.

SARs with HCPCS Level III local codes received on or after August 27, 2018 may be denied. Providers may need to resubmit SARs with the appropriate HCPCS Level II national codes.

Additional information for this conversion will publish as details are determined. Providers are encouraged to routinely check the Medi-Cal Update provider bulletins and complete the MCSS Form to receive email notifications for newly published Medi-Cal Update bulletins, Newsflash articles and/or System Status Alerts.

Providers may also request additional onsite or telephone support via the Telephone Service Center (TSC) at 1-800-541-5555, from 8 a.m. to 5 p.m., Monday through Friday, except holidays. Providers calling from outside of California can contact TSC at 1-916-636-1200.