Correction: EPSDT Code Conversion Policy Overview

August 10, 2018

In July 2018, policy instructions were published regarding the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services code conversion. This correction pertains to the information published in the Medi-Cal Update provider bulletins and Newsflashes. The policy effective date and Treatment Authorization Requests (TAR) instructions have changed. Please see subheadings below for important TAR/eTAR information.

Effective for dates of service on or after September 1, 2018, HCPCS Level III local EPSDT service code Z5868 will be replaced with HIPAA-compliant national HCPCS Level II code T1026 as shown in the crosswalk below. This conversion will also include the use of the EP modifier to indicate EPSDT services.

TAR Conversion Policy for Previously Approved, Retroactive and Deferred TARs
All TARs processed and approved on or before August 31, 2018 may be processed using the current HCPCS Level III local code Z5868. Claims for these TARs can be submitted with HCPCS Level III local code Z5868 until the end date of that TAR.

TARs Submitted On or After September 1, 2018
TARs originated on or after September 1, 2018 must be submitted using the national HCPCS Level II code T1026. TARs approved beyond September 1, 2018, with HCPCS Level III local codes will be deferred for correction. Claims for these TARs must be submitted using national HCPCS Level II codes.

Guidelines for TAR/eTAR submissions are located in the Part 1 Medi-Cal provider manual.

Local Code – Description National Procedure Codes – Description Modifier – Description
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 diagnostic and treatment (EPSDT).

Additional information for this code 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.