EPSDT Well Visits
What is the AHCCCS EPSDT Program?
Early and Periodic Screening, Diagnostic and Treatment Program (EPSDT) is Medicaid’s federally mandated comprehensive child health program of prevention, treatment, correction, and improvement of physical and behavioral/mental health conditions for AHCCCS members up to 21 years of age.
The goal of the program is to ensure members have access to age-appropriate screening, preventive services and treatment that are medically necessary to correct or improve any identified conditions, offering the right care at the right time in the right setting.
The EPSDT program is key in ensuring children receive appropriate preventive, dental, mental health, developmental and specialty services. Elements of the program include:
The Periodicity Schedule can be viewed by accessing the AHCCCS’ website.
- Comprehensive health and developmental history, including growth and development screening (includes physical, nutritional and behavioral health assessments)
- Developmental screening (using an AHCCCS approved developmental screening tool) for members ages 9, 18 and 30 months
- Autism Spectrum Disorder (ASD) Specific Developmental Screening at the 18 months and 24 months
- Comprehensive unclothed physical examination
- Appropriate immunizations according to age and health history
- Laboratory tests appropriate to age and risk for the following: blood lead, tuberculosis skin testing, anemia testing and sickle cell trait
- Health education and counseling about child development, healthy lifestyles and accident and disease prevention
- Appropriate dental screening and referral
- Appropriate vision and hearing/speech testing
- Obesity screening using the BMI percentile for children and weight for length growth chart for members under 2 years of age
- Age appropriate anticipatory guidance
- Newborn
- 3-5 days
- 1 month
- 2 month
- 4 month
- 6 month
- 9 month
- 12 month
- 15 month
- 18 month
- 24 month
- 30 month
- Annually from age 3 – up to 21 years
Best Practices
- Members (3 – up to 21 years of age) can be scheduled and seen for a well visit once every calendar year
- Waive sports physicals fee by billing and converting into well visits by:
- Adding anticipatory guidance
- Taking physical and mental development histories
- Updating immunizations
- Perform a sick visit and well-child visit on the same day by adding a modifier 25 to the sick visit and billing for the appropriate well visit.
Arizona Complete Health covers dental checkups and cleanings for members under the age of 21; a referral is not needed.
Coverage includes:
- Dental exams
- Dental cleanings
- Fillings for cavities
- X-rays
- Application of fluoride
- Dental sealants
- Emergency dental services
Dental Periodicity Schedule - Policy 431 - Attachment A (PDF)
Arizona Complete Health-Complete Care Plan covers eye exams and vision screenings for members up to the age of 21. A referral is not needed.
Coverage includes:
- Regular eye exams
- Vision screening
- Prescription eyeglasses
- Repairs or replacements of broken or lost eyeglasses
- Replacement due to change in prescription
Vaccines for Children (VFC) Program
The Vaccines for Children (VFC) Program is a federally funded program that provides vaccines at no cost to children who might not otherwise be vaccinated because of inability to pay. The program was officially implemented in October 1994 as part of the President's Childhood Immunization Initiative. Funding for the VFC Program allows the Centers for Disease Control and Prevention (CDC) to buy vaccines at a discount from the manufacturers and distribute them to state health departments and certain local and territorial public health agencies, which in turn distribute them at no charge to private physician offices and public health clinics registered as VFC providers.
*Excerpted from the Federal VFC Operations Guide
If you have any questions, please contact the Arizona VFC Program at (602) 364-3642.
The Arizona State Immunization Information System (ASIIS)
The Arizona State Immunization Information System (ASIIS) is an immunization registry designed to capture immunization data on individuals within the state. Providers are mandated under Arizona Revised Statute (ARS) §36-135 to report all immunizations administered to children 18 years of age and younger to the state's health department. The registry serves as a receptacle for accommodating these reported data. In this capacity, the registry then provides a valuable tool for the management and reporting of immunization information to public health professionals, private and public healthcare providers, parents, guardians and other child care personnel.
Arizona State Immunization Information System (ASIIS)
150 N. 18th Avenue, #120
Phoenix, AZ 85007
(877) 491-5741
(602) 364-3285 Fax
Community resources are available to providers to support our members is their growing stages of life. These resources can be utilized during a well child visit when appropriate.
Please visit our Community Resource Page to download an update Community Resource Guide:
Additional Community Resources for bulling, violence, drug, alcohol, suicide prevention and social media, sexual bBehavior and lung education are listed below.
Organization | Organization Description | Region |
|---|---|---|
Casa Center | “The Power of YOU” is a school-based bullying prevention program that targets the roots of bullying, abuse and violence by boosting core emotional intelligence competencies in children, youth and the important adults in their lives. Rather than focusing on a particular problem (like “bullying” “dating violence” or “sexual abuse”) the program focuses on building positive behaviors and reducing negative behaviors
| Statewide |
Teens Against Bullying: pacerteensagainstbullying.org Videos by kids and celebrities, webisodes, games, contests, online petition and more. Also, classroom toolkits, student action plan and pledge, create a video toolkit, and art/music/dance activities | National | |
|
| Works to empower and educate youth, families and communities with the knowledge and courage to identify and prevent negative youth behavior. Peer-to-peer education programs address drug abuse, alcohol abuse, bullying, unhealthy relationships, eating disorders, depression/self injury, and internet safety | Statewide |
American Lung Association goals are big—defeat lung cancer, create a tobacco-free future, champion clean air for all, and improve the quality of life for those living with lung disease. Community resources include education to keep kids off tobacco, including e-cigarettes, or advocating for laws that protect the air we all breathe. | Nationwide |
Chapter 400 - Medical Police for Maternal and Child Health - Section 430, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services
- Attachment A, AHCCCS EPSDT Periodicity Schedule
- Attachment B, AHCCCS Cert. of Medical Necessity for Comm. Oral Nutritional Supplements
- Attachment C, Procedures for the Coordination of Services Under EPSDT and Early Intervention
- Attachment D, Arizona Early Intervention Program (AzEIP) AHCCCS Member Service Request