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Back  RFI # 907: Medicaid EPSDT Indicator Usage

Formal vs. Informal Help Informal Formal

Submitter

Greg Dawson

Description

The 837P guide indicates that the EPSDT Indicator (Loop 2400 SV111) is required "if Medicaid services are the result of a screening referral". Could we get a definition of what this means, please? If there are any references to where this is defined in statute this would be very helpful.

Thanks.

Response

Federal Medicaid law at 42 U.S.C.ยง 1396d(r) [1905(r) of the Social Security Act] requires state Medicaid programs to provide Early and Periodic Screening, Diagnostics, and Treatment (EPSDT) for recipients under 21 years of age. If the service being reported on the claim to a Medicaid Agency was performed due to a referral from screening services included in this program, then a Y would be sent in the EPSDT Indicator (Loop 2400 SV111). As the program implementation could vary from state to state, more specific information should be obtained from the state Medicaid Agency involved.
Submission 11/17/2009
Status Date 3/26/2010
Status F - Final
Primary References
Document 004010X098
Section3.1
Page406
Set IDSV111
Loop2400
Segment IDSV1