CurrentHealth Choice ArizonaPolicy 430

AHCCCS Early and Periodic Screening, Diagnostic and Treatment Periodicity Schedule

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Provides the AHCCCS periodicity schedule for preventive screening, assessment, testing, immunizations, and developmental services for children from the newborn period through adolescence, including guidance for primary care providers on when services should be performed.

Policy Summary

PayerHealth Choice Arizona

PolicyAHCCCS Early and Periodic Screening, Diagnostic and Treatment Periodicity Schedule

Policy CodePolicy 430

Change TypeNo material change

Effective DateOct 1, 2025

Next Review DateN/A

Key ActionBring the child's screening schedule up to date at the earliest possible time when scheduled items were missed or the child first presents.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Newborn–19 yearsSchedule age range

6 monthsOral-health screenings begin

Every 3 monthsFluoride varnish frequency

Every 6 monthsRepeat dental examinations

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CurrentHealth Choice ArizonaPolicy 430

AHCCCS Early and Periodic Screening, Diagnostic and Treatment Periodicity Schedule

Customize your policy alerts

Sign up for health_choice_arizona Policy 430 alerts

Get alerted when Policy 430 changes without checking for updates manually.

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Policy Summary

PayerHealth Choice Arizona

PolicyAHCCCS Early and Periodic Screening, Diagnostic and Treatment Periodicity Schedule

Policy CodePolicy 430

Change TypeNo material change

Effective DateOct 1, 2025

Next Review DateN/A

Key ActionBring the child's screening schedule up to date at the earliest possible time when scheduled items were missed or the child first presents.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Newborn–19 yearsSchedule age range

6 monthsOral-health screenings begin

Every 3 monthsFluoride varnish frequency

Every 6 monthsRepeat dental examinations

1 lifetimeOcular photo screening limit

Policy Scope and Purpose

This attachment presents the AHCCCS Early and Periodic Screening, Diagnostic and Treatment (EPSDT) preventive-care periodicity schedule for pediatric members from the newborn period through 19 years of age. It organizes preventive assessments, screenings, testing, immunizations, developmental services, oral-health services, and anticipatory guidance by age or age range. Vision, hearing, and speech services are addressed in separate schedules.

The schedule establishes minimum requirements for age-based preventive care. Providers should bring a child's schedule up to date at the earliest possible time when the child first enters care or a scheduled service was missed, and should perform additional procedures, tests, or screenings when medically indicated.

EPSDT Coverage Requirements

EPSDT minimum and catch-up requirements

The schedule establishes minimum requirements.

Minimum EPSDT obligations: Perform the services identified by the periodicity schedule at the applicable ages or age ranges.Applicable schedule age or range

The schedule includes preventive screenings, testing, oral-health services, dental referrals, and anticipatory guidance.

Additional medical necessity: Perform any other procedures, tests, or services whenever medically indicated, even if they are not listed in the schedule.Medical indication

These additional services are covered.

Catch-up requirement: When a child enters care for the first time at any point in the schedule, or when scheduled items were missed, bring the schedule up to date at the earliest possible time.First presentation or missed scheduled service

Do not wait for the originally suggested age once catch-up is indicated.

Additional interperiodic screenings

Additional screening is covered when medically necessary.

Additional screening basis: Use AAP screening guidelines or provide more screenings when medically necessary.AAP-guideline screening or medical necessity

Additional interperiodic screenings are covered.

Fluoride varnish

Fluoride varnish in the primary care provider's office is covered only when all listed conditions are met.

Primary-care fluoride varnish: Provide fluoride varnish during an EPSDT visit in a primary care provider's office for a child who has reached 6 months of age and has at least one tooth erupted.Age >= 6 months; at least one tooth erupted; no more than once every 3 months; recurrent applications through age 5

The frequency and age limits apply to primary-care-office fluoride varnish.

Dental examination and referral

Dental examinations follow the initial-age and repeat-interval requirements.

Dental examination timing: The first dental examination may occur as early as 6 months of age, followed by repeat examinations every 6 months or as indicated by the child's risk status or susceptibility to disease.Initial exam as early as 6 months; repeat every 6 months or risk-based

Parents of young children may self-refer to a dentist within the Contractor's network at any time; referrals are encouraged by age one.

Minimum EPSDT schedule requirements

Apply the periodicity schedule as a minimum standard and bring the schedule up to date at the earliest possible time.

Minimum EPSDT requirements: If a child first comes under care at any point on the schedule, or if a scheduled item was not completed at the suggested age, the provider must bring the schedule up to date as soon as possible.As soon as possible

The physician is obligated to perform other procedures or tests whenever medically indicated.

Additional interperiodic screenings

Additional interperiodic screening is covered when medically necessary.

Additional screening coverage: Additional interperiodic screenings are covered when the AAP screening guidelines are used and/or when more screenings are medically necessary.More screenings than the periodicity schedule

Vaccine recommendations are referenced separately through the 2025 United States child and adolescent immunization schedule and additional vaccine tables.

Ocular photo screening

Ocular photo screening is covered as part of the EPSDT visit for the specified pediatric age range.

Covered ocular photo screening: Ocular photo screening with bilateral interpretation and report is covered for children ages three through six as part of the EPSDT visit.Age 3 through 6 years

Coverage is limited to one screening over the member's lifetime.

Newborn hearing screening

Newborn hearing screening and follow-up must follow the hearing/speech schedule.

Newborn hearing screening: All newborns should be screened for hearing loss at birth and screened again two to six weeks afterward when the first screening indicates the need or when screening was not completed at birth.At birth; repeat at 2-6 weeks when indicated or missed

All children, including newborns, who meet risk criteria for hearing loss should receive objective screening.

Service Timing and Frequency Reference

Fluoride varnish

FrequencyOnce every three months

SettingPrimary care provider's office

Visit typeEarly and Periodic Screening, Diagnostic and Treatment (EPSDT) visit

EligibilityChild is at least 6 months old and has at least one tooth erupted

ContinuationRecurrent applications may continue through 5 years of age

Oral health screening

ProviderPrimary care provider

Operational Requirements

Documentation Required

Newborn Metabolic Screening Follow-Up

Perform newborn metabolic screening in accordance with state law. Review results at visits and complete appropriate retesting or referral as needed.

Documentation Required

Primary-Care Oral-Health Screening

The primary care provider must conduct an oral-health screening at every visit beginning at 6 months of age.

Billing Rule

Fluoride Varnish Limits

Schedule and Screening Notation

Schedule notation

Symbolx

MeaningService is to be completed

Schedule useIdentifies services that are required at the applicable age or age range

Risk-based notation

Symbol+

MeaningService is to be performed for members at risk when indicated

FrequencyThe service may be performed more frequently when indicated or when the child is at increased risk

Policy Summary

PayerHealth Choice Arizona

PolicyAHCCCS Early and Periodic Screening, Diagnostic and Treatment Periodicity Schedule

Policy CodePolicy 430

Change TypeNo material change

Effective DateOct 1, 2025

Next Review DateN/A

Key ActionBring the child's screening schedule up to date at the earliest possible time when scheduled items were missed or the child first presents.

SourceLink

On This Page

FrequencyAt each primary care visit

Starting age6 months of age

Dental examination

Initial examinationAs early as 6 months of age

Routine repeat intervalEvery six months

Risk-based timingRepeat as indicated by the child's risk status or susceptibility to disease

Newborn metabolic screening

TimingAccording to applicable state law

Result reviewReview results at visits

Follow-upPerform appropriate retesting or referral as needed

Fluoride varnish provided in a primary care provider's office is limited to one application every three months during an EPSDT visit for eligible children.

The child must be at least 6 months old.
At least one tooth must have erupted.
Recurrent applications may continue through 5 years of age.

Note

Dental Examination Schedule

Arrange the first dental examination as early as 6 months of age. Repeat examinations every six months or as indicated by the child's risk status or susceptibility to disease.

Documentation Required

Catch-Up Scheduling

These are minimum requirements. If a child enters care late or any scheduled service was missed or delayed, bring the screening schedule up to date at the earliest possible time; perform additional medically indicated procedures or tests when needed.

Additional interperiodic screenings that are medically necessary are covered.
Physicians are obligated to perform other medically indicated procedures and tests.

Billing Rule

Ocular Photo Screening Lifetime Limit

Ocular photo screening with interpretation and report, bilateral, is covered for children ages 3 through 6 as part of the EPSDT visit when cooperation with traditional vision screening is challenging. Coverage is limited to one ocular photo screening over the member's lifetime.

Lifetime limit: one covered screening.

Age-range notation

Symbol- x

RangeService may be provided during the indicated range

Preferred ageThe x identifies the preferred age within that range

Interperiodic screening

CoverageAdditional interperiodic screenings are covered when medically necessary

Guideline basisScreenings may be based on American Academy of Pediatrics guidelines

Beyond scheduleAdditional screenings beyond those listed in the periodicity schedule may be performed when medically necessary

EPSDT schedule symbols

xService is to be completed

+Service is to be performed for members at risk when indicated

- xService may be provided during the indicated range, with x identifying the preferred age

Screening method symbols

SSubjective assessment by history

OObjective assessment by a standard testing method

+Service may be performed more frequently when indicated or when the child is at increased risk

Vision rescreening notation

NotationAsterisk (*)

Applies toVision screening

Required follow-upIf the member is uncooperative, rescreen in six months

Hearing-loss risk notation

PopulationAll children, including newborns, who meet risk criteria for hearing loss

Screening methodObjective screening

Risk criterionRisk criteria for hearing loss