Summary & Overview
HCPCS S0302: EPSDT Screening, Diagnosis, and Treatment Service
HCPCS Level II code S0302 designates a completed Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) service provided in addition to an appropriate evaluation and management visit. EPSDT is a core component of pediatric preventive care for Medicaid-eligible children and adolescents; this code flags that the comprehensive screening and any indicated diagnostic or treatment steps tied to EPSDT were completed during the encounter. Nationally, accurate use of this code matters for documenting compliance with pediatric preventive care standards and for payers that track EPSDT service delivery.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the clinical context for EPSDT-coded visits, common billing considerations, payer coverage patterns, and benchmark-oriented metrics where available. The publication summarizes coding intent, typical sites of service, and common modifier usage (listed separately), and identifies gaps where data was not provided.
This summary is intended for billing managers, pediatric clinicians, and policy analysts seeking a concise reference to HCPCS Level II code S0302, its role in preventive pediatric care, and the payer environment nationally.
Billing Code Overview
HCPCS Level II code S0302 describes a completed Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) service provided in addition to an appropriate evaluation and management service. The code denotes that the EPSDT visit components required for children and adolescents were completed as part of the encounter.
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Service type: Preventive pediatric EPSDT screening, diagnosis, and treatment services performed alongside an evaluation and management visit
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Typical site of service: Ambulatory clinic or office setting where pediatric primary care, preventive, or well-child services are delivered
Clinical & Coding Specifications
Clinical Context
A 4-year-old child presents to a pediatric primary care clinic for a well-child visit under the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program. The visit includes a comprehensive evaluation and management service for preventive care and developmental screening. The clinician completes the EPSDT-specific components: full history, physical exam, age-appropriate developmental and behavioral screening, immunization review, vision and hearing checks, oral health assessment, nutritional counseling, and anticipatory guidance. When additional diagnostic or therapeutic services are provided or ordered (for example, laboratory testing, immunizations, vision referral, or dental referral), the clinician appends the EPSDT add-on service S0302 in addition to the primary evaluation and management CPT code for the visit. Typical workflow: patient check-in and immunization reconciliation; nursing screening (height/weight/vitals, lead risk questionnaire); clinician evaluation and developmental screening; documentation of EPSDT components and required parental counseling; orders for any needed diagnostics or referrals; coding for the primary E/M CPT and the EPSDT add-on S0302 to indicate completion of the EPSDT service.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services |