Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)
Early and Periodic Screening, Diagnosis,and Treatment (EPSDT) is a Medi-Cal benefit for individuals under the age of 21 who have full-scope Medi-Cal eligibility. This benefit allows for periodic screenings to determine health care needs. Based upon the identified health care need, diagnostic and treatment services are provided.
WHAT SERVICES ARE OFFERED UNDER THE EPSDT BENEFIT?
EPSDT services include all services covered by Medi-Cal. In addition to the regular Medi-Cal benefits, a beneficiary under the age of 21 may receive additionally medically necessary services. These additional services are known as EPSDT Supplemental Services and include: private duty nursing services from a Registered Nurse (RN) or a Licensed Vocational Nurse (LVN), Case Management, Pediatric Day Health Care, and Nutritional and Mental Health Evaluations and Services.
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HOW DOES ONE REQUEST EPSDT SERVICES?
The provider must submit the request for services to Systems of Care on a Treatment Authorization Request (TAR).
In addition to the TAR, the provider must also submit the following medical documentation:
- Medical information, which supports the medical necessity for the requested services;
- Assessment of medical care needs, i.e., nursing care, and;
- Plan of Treatment signed by a physician.
FOR MORE INFORMATION ABOUT EPSDT:
Telephone: (213) 620-2115