EPSDT - Well Child Visits

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EPSDT Program

Well-Child Care / Early and Periodic Screening, Diagnostic and Treatment (EPSDT)

B – UFC/AALTCS wants to help your children grow up healthy. Early Periodic Screening, Diagnostic and Treatment (EPSDT) is a comprehensive child health program of prevention, treatment, correction, and improvement (amelioration) of physical and mental health problems for AHCCCS members under the age of 21.

The purpose of EPSDT is to ensure the availability and accessibility of health care resources, as well as to assist Medicaid members in effectively utilizing these resources.

EPSDT services provide comprehensive health care through primary prevention, early intervention, diagnosis, medically necessary treatment, and follow-up care of physical and behavioral health problems for AHCCCS recipients less than 21 years of age.

EPSDT services include screening services, vision services, dental services, hearing services, and all other medically necessary mandatory and optional services listed in federal law 42 USC 1396d (a) to correct or ameliorate defects and physical and mental illnesses and conditions identified in an EPSDT screening whether or not the services are covered under the AHCCCS state plan.

Limitations and exclusions, other than the requirement for medical necessity and cost effectiveness do not apply to EPSDT services.

A well-child visit is synonymous with an EPSDT visit and includes all screenings and services described in the AHCCCS EPSDT and dental periodicity schedules.

Amount, Duration, and Scope: The Medicaid Act defines EPSDT services to include screening services, vision services, dental services, hearing services and “such other necessary health care, diagnostic services, treatment and other measures described in federal law subsection 42 USC 1396d(a) to correct or ameliorate defects and physical and mental illnesses and conditions discovered by the screening services, whether or not such services are covered under the (AHCCCS) state plan.

This means that EPSDT covered services include services that correct or ameliorate physical and mental defects, conditions, and illnesses discovered by the screening process when those services fall within one of the 29 optional and mandatory categories of “medical assistance” as defined in the Medicaid Act. Services covered under EPSDT include all 29 categories of services in the federal law even when they are not listed as covered services in the AHCCCS state plan, AHCCCS statutes, rules, or policies as long as the services are medically necessary and cost effective.

EPSDT includes, but is not limited to, coverage of inpatient and outpatient hospital services, laboratory and x-ray services, physician services, nurse practitioner services, medications, dental services, therapy services, behavioral health services, medical supplies, prosthetic devices, eyeglasses (with unrestricted repair or replacement), transportation, and family planning services. EPSDT also includes diagnostic, screening, preventive, and rehabilitative services. However, EPSDT services do not include services that are solely for cosmetic purposes, or that are not cost effective when compared to other interventions.

EPSDT/Well-Child Visits Include:

  • A comprehensive health and developmental history, including growth and development screening which includes physical, nutritional, and behavioral assessments
  • Nutritional Assessment provided by a PCP
  • Behavioral Health Screening and services provided by a PCP
  • Developmental Screening Tools used by a PCP
  • A comprehensive unclothed physical examination
  • Appropriate immunizations according to age and health history
  • Laboratory tests including blood lead screening assessment and blood lead testing appropriate to age and risk. Required blood lead screening for children under six years of age is based on the child's risk as determined by either the member's residential zip code or presence of other known risk factors.
  • Health education, counseling, and chronic disease self-management
  • Appropriate oral health screening, intended to identify oral pathology, including tooth decay and/or oral lesions, and the application of fluoride varnish conducted by a physician, physician assistant or nurse practitioner.
  • Appropriate vision, hearing and speech screenings
  • TB testing as appropriate to age and risk
  • Eye examinations and prescriptive lenses (to include unrestricted repair or replacement)
  • Ocular Photo screening for children ages 3-5 is covered when due to challenges with a child's ability to cooperate with traditional vision screening techniques. Limited to lifetime coverage of 1
  • Medicines listed in the B – UFC/ACC Drug List 
  • Special medical foods when medically necessary

Well-Child Care Will Also Give You Ideas About How to:

  • Keep your child well
  • Protect your child from getting hurt
  • Spot health problems early
  • Apply for services like WIC, Head Start, Children's Rehabilitative Services (CRS), and the Arizona Early Intervention Program (AzEIP).

EPSDT Well-Child Visits

It is important for your child to visit their doctor for, and Early Periodic Screen Diagnosis and Treatment (EPSDT) visit which is also known as a Well Child Visit.

EPSDT visits are important for all infants, children, and young adults under 21. There are no charges or co-payments for EPSDT services or any related services for any child under the age of 21 on our health plan. 

Your child’s doctor will want to see your child for their wellness visits at: 

  • 3-5 days old
  • 1 month old
  • 2 months old
  • 4 months old
  • 6 months old
  • 9 months old
  • 12 months old
  • 15 months old
  • 18 months old
  • 2 years old (24 months)
  • 2 ½ years old (30 months) 
  • 3 years old and yearly after until 21 years old

There are many benefits to an EPSDT visit including: 

  • Prevention. Your child gets scheduled immunizations to prevent illness. You also can ask your pediatrician about nutrition and safety in the home and at school.
  • Tracking growth & development. See how much your child has grown in the time since your last visit and talk with your doctor about your child's development. You can discuss your child's milestones, social behaviors, and learning.
  • Raising any concerns. Make a list of topics you want to talk about with your child's pediatrician such as development, behavior, sleep, eating or getting along with other family members. 
  • Team approach: Your child’s doctor can also refer your child to any specialists that your child may need to help with their continued wellness. These referrals are covered by your health plan.

An EPSDT Visit includes: 

  • A comprehensive health and developmental history, including growth and development screening which includes physical, nutritional, and behavioral assessment.
  • Nutritional Assessment provided by a PCP. 
  • Behavioral Health Screening and services provided by a PCP.
  • Developmental Screening Tools used by a PCP. 
  • A comprehensive physical examination. 
  • Appropriate immunization according to age and health history.
  • Laboratory and x-ray tests include blood lead screening assessment and blood lead testing appropriate to age and risk. Blood lead testing is required for all children at 12 and 24 months of age. Blood lead testing is also needed for any 2 to 6-year-old child that has missed earlier tests or when medically needed.
  • Health education, counseling, and chronic disease self-management.
  • Appropriate oral health screening, intended to identify oral pathology, including tooth decay and/or oral lesions, and the application of fluoride varnish conducted by a physician, physician assistant or nurse practitioner.
  • Appropriate vision, hearing, and speech screenings.
  • TB testing as appropriate to age and risk.

EPSDT services also include:

  • Dental Benefits
  • Preventative Care
  • Fluoride Treatments
  • Dental X-rays
  • Sealants
  • Emergency Care
  • Regular Maintenance
  • Two professional teeth cleanings every year
  • Vision Services including eyeglasses
  • Hearing Services 

EPSDT Visits do not include services that are experimental, that are solely for cosmetic purposes, or that are not cost effective when compared to other interventions.

If you think something may be wrong between visits, call your baby’s provider. In many cases they can answer your questions over the phone. If not, they’ll make an appointment for you to bring your baby in for an office visit. Many of the things new parents worry about turn out to be minor problems.

If you need assistance with transportation to and from medical appointments, please reach out to our Customer Care Center.