Epsdt Tip Sheet
Guidance on EPSDT benefits available to Medicaid-enrolled children under 21 in New Mexico, outlining services included, tips for providers, and commonly used CPT/Evaluation codes for preventive and well-child services.
No material clinical/coverage changes.
EPSDT Tip Sheet — High-level Summary
EPSDT (Early and Periodic Screening, Diagnostic and Treatment) is a Medicaid benefit that provides comprehensive and preventive health care services for children under 21 enrolled in Medicaid. It covers screening, diagnosis, and treatment and a broad array of services — including immunizations, dental, vision, hearing, therapies, developmental screenings, laboratory tests, and more — to ensure each child receives needed care. New Mexico Medicaid providers should follow EPSDT guidance to deliver appropriate screenings and services, recognize that any qualified provider within their state scope can provide screenings, and use the listed preventive and E/M CPT and required 'Z' diagnosis codes when billing EPSDT services.