CurrentAlaska MedicaidPolicy N/A

EPSDT fee schedule and billing guidance

This document provides Alaska Medicaid's EPSDT (Early and Periodic Screening, Diagnostic, and Treatment) fee schedule rates, billing notes, and allowed diagnosis (Z) codes for EPSDT procedures; it affects providers billing Alaska Medicaid for EPSDT services.

Policy Summary

PayerAlaska Medicaid

PolicyEPSDT fee schedule and billing guidance

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateJul 1, 2025

Next Review DateN/A

Key ActionWhen billing EPSDT procedures, use an applicable 'Z' diagnosis code from the provided list; no prior authorization is required for these codes.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

7/1/2025–6/30/2026policy effective period

MultipleCPT codes on schedule

100%mid-level reimbursement

Z codes requireddiagnosis coding

nearest centrate rounding

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EPSDT coverage and billing requirements

Coverage and billing rules for EPSDT-coded services:

Codes listed on the EPSDT fee schedule are covered as indicated by included base rates and billing notes.

Mid-level providers are reimbursed at 100% of the physician rate when billing the listed EPSDT codes.

When billing as an EPSDT procedure, use the applicable 'Z' diagnosis code from the provided list.

None of the listed codes require service authorization or medical justification.

Rates are RBRVS-based and rounded to the nearest cent following adjustments for multiple units and cutbacks; reimbursement may vary slightly due to rounding.

EPSDT Codes, Rates, and Rounding

EPSDT preventive and office E/M CPT codesCPTCovered

99381	Initial preventive medicine E/M new patient - infant
99382	Initial preventive medicine E/M new patient 1-4 yrs
99383	Initial preventive medicine E/M new patient 5-11 yrs
99384	Initial preventive medicine E/M new patient 12-17 yrs
99385	Initial preventive medicine E/M new patient 18-39 yrs
99391	Periodic preventive medicine reevaluation established patient infant
99392	Periodic preventive medicine established age 1-4
99394	Periodic preventive medicine established age 12-17
99395	Periodic preventive medicine established age 18-39
99202	Office/outpatient visit new

1–10 of 16

1/2

Allowed EPSDT diagnosis (Z) codesICD-10

Z00.00	Encounter for general adult medical examination without abnormal findings
Z00.01	Encounter for general adult medical examination with abnormal findings
Z00.129	Encounter for routine child health examination without abnormal findings
Z00.121	Encounter for routine child health examination with abnormal findings
Z00.110	Health examination for newborn under 8 days old
Z00.111	Health examination for newborn 8 to 28 days old

Rate rounding — RBRVS-based rates rounded to nearest cent after adjustments

Rounding ruleRBRVS-based rates are rounded to the nearest cent following adjustments for multiple units and cutbacks.

Effect on reimbursementReimbursement may vary slightly from published rates as a result of rounding.

ApplicabilityRounding applies after all rate adjustments (e.g., multiple units, cutbacks) are calculated.

Key Terms

EPSDT — Early and Periodic Screening, Diagnostic, and Treatment services

DefinitionEarly and Periodic Screening, Diagnostic, and Treatment (EPSDT) services for Medicaid members.

Covered servicesProcedures listed on the EPSDT fee schedule (preventive medicine E/M, periodic visits, newborn services, and select office/outpatient E/M codes) are covered as indicated by included base rates and billing notes.

AuthorizationNone of the listed EPSDT codes require service authorization or medical justification.

Diagnosis codingWhen billing as an EPSDT procedure, use an applicable 'Z' diagnosis code from the EPSDT Diagnosis Codes list.

Mid-level providers — reimbursement rule

Reimbursement levelMid-level providers are reimbursed at 100% of the physician base rate when billing the listed EPSDT codes.

ScopeApplies to the preventive and periodic E/M codes and other EPSDT-listed procedures shown on the fee schedule (see individual code rows).

Billing note placementThe fee schedule entry for each EPSDT code includes the billing note specifying mid-level reimbursement at 100% of physician rate.