CurrentHumanaPolicy CP2026007

Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Provider

Defines Humana Kentucky Medicaid billing requirements for EPSDT providers reporting occupational therapy, physical therapy, and speech-language pathology services, including required provider type, codes, and modifiers.

Policy Summary

PayerHumana

PolicyEarly and Periodic Screening, Diagnosis and Treatment (EPSDT) Provider

Policy CodePolicy CP2026007

Change TypeNo material change

Effective Date04/2026

Next Review DateN/A

Key ActionEnsure billing provider NPI and taxonomy correspond to state-assigned provider type 45 and report Modifier EP in the first modifier position.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Provider type 45state-assigned provider type required

Modifier EPEPSDT service indicator

GN/GO/GPRendering-provider specialty modifier

Modifier 59Distinct procedural service rule

State fee schedulesCode eligibility requirement

EPSDT Therapy Billing Criteria

EPSDT therapy billing criteria

Humana requires EPSDT providers to meet the following billing criteria for therapy services:

Billing provider NPI and taxonomy must correspond to state-assigned provider type 45.

Procedure codes billed must be included on the state-published speech therapy, physical therapy, or occupational therapy fee schedules.

Modifier EP is required and must be listed in the first modifier position.

An appropriate rendering-provider modifier (GN, GO, or GP) is required based on the specialty of the rendering provider, and must be reported in a modifier position other than the first.

Modifier 59 is required, reported in a modifier position other than the first, when multiple therapy types are administered to the same member on the same date of service.

Policy Summary

PayerHumana

PolicyEarly and Periodic Screening, Diagnosis and Treatment (EPSDT) Provider

Policy CodePolicy CP2026007

Change TypeNo material change

Effective Date04/2026

Next Review DateN/A

Key ActionEnsure billing provider NPI and taxonomy correspond to state-assigned provider type 45 and report Modifier EP in the first modifier position.

SourceLink

On This Page

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Modifiers and Code Requirements

Required modifiersModifierCovered

Modifier EP	Service provided as part of Medicaid early periodic diagnosis and treatment
Modifier GN	Services delivered under an outpatient speech language pathology plan of care
Modifier GO	Services delivered under an outpatient occupational therapy plan of care
Modifier GP	Services delivered under an outpatient physical therapy plan of care
Modifier 59	Distinct procedural service

Modifier EP position

RequirementModifier EP must be listed in the first modifier position on the claim.

ContextApplies to EPSDT therapy services billed under Humana Kentucky Medicaid.

Related ruleRendering-provider modifiers (GN/GO/GP) must be reported in a modifier position other than the first.

Provider Billing Requirements and Actions

Billing Rule

EPSDT therapy billing requirements — NPI/taxonomy, fee schedule, and modifiers

Ensure the billing provider NPI and taxonomy match the state-assigned provider type 45 and only bill procedure codes that appear on the state-published speech, physical, or occupational therapy fee schedules. Report Modifier EP in the first modifier position; report the appropriate rendering-provider modifier (GN, GO, or GP) in a modifier position other than the first; and report Modifier 59 (also not in the first position) when multiple therapy types are provided to the same member on the same date of service.

Billing provider NPI and taxonomy must correspond to state-assigned provider type 45.
Procedure codes billed must be on the state-published speech, physical, or occupational therapy fee schedules.
Modifier EP is required and must be listed in the first modifier position.
Modifier GN, GO, or GP is required (based on rendering-provider specialty) in a modifier position other than the first.
Modifier 59 is required (in a modifier position other than the first) when multiple therapy types are administered to the same member on the same date of service.

Modifier Definitions

Modifier EP — definition

TermModifier EP

DefinitionService provided as part of Medicaid early periodic diagnosis and treatment

Usage noteRequired on EPSDT therapy claims and must be in the first modifier position (see coding rules).

Modifier 59 — definition

TermModifier 59

DefinitionDistinct procedural service

Usage noteReport Modifier 59 in a modifier position other than the first when multiple therapy types are provided to the same member on the same date of service.

Modifier GN — definition

TermModifier GN

DefinitionServices delivered under an outpatient speech language pathology plan of care

Usage noteReport GN to indicate the rendering provider specialty; do not place in the first modifier position when EP is required.

Modifier GO — definition

TermModifier GO

DefinitionServices delivered under an outpatient occupational therapy plan of care

Usage noteReport GO to indicate the rendering provider specialty; place in a modifier position other than the first when EP is also reported.

Modifier GP — definition

TermModifier GP

DefinitionServices delivered under an outpatient physical therapy plan of care

Usage noteReport GP to indicate the rendering provider specialty; do not use as the first modifier when Modifier EP is required.