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North Carolina Medicaid Preventive examination and screening services - CPT Coverage and Limitations


Regular Periodic Examination - Birth through 20 years


CPT code(s): 99381-9985; 99391-99395

ICD: V20.2

Modifier: EP Modifier is required in block 24D

Developmental Screening (at 6, 12, 18 or 24 months of age, at age 3, 4, and 5 years of age)

A formal, standardized developmental screening tool must be used during periodic screening assessments for children ages 6, 12, 18 or 24 months, and 3, 4, and 5 years of age.

CPT Code(s): 96110

ICD: V20.2

Modifier: EP Modifier is required in block 24D

Health Risk Assessments (GAPS/HEADSSS) and Behavioral/Mental Health Screening (PSC/SDQ/PSQ-A/Beck’s)

A health risk assessment (e.g. Bright Futures Tool Kit/GAPS/HEADSSS) is recommended to be performed on youth ages 11-20.The health risk assessment and an evidence-based developmental, behavioral-mental health screening can be billed using CPT 99420 EP (maximum of 2 units can be billed per date of service)

CPT code(s): 99420

ICD: V20.2

Modifier: EP Modifier is required in block 24D

Vision Screening

Objective screenings must be performed during every Periodic screening assessment beginning at age 3 through age 10 years. Starting at age 11 years, vision screenings must be performed once every three years. Selectively screen vision at other ages based on the provider’s assessment of risk, including any academic difficulties.

CPT Code(s): 99172 or 99173

ICD: V20.2

Modifier: EP Modifier is required in block 24D

Hearing Screening

Objective screenings using an otoacoustic auditory emission (OAE) tool or audiometer (auditory sweep) must be performed annually for children ages 4-10. At all other ages, selectively screen based on the provider’s assessment of risk. Screening must occur if the parent is concerned about the child’s hearing, speech or language OR the child is exposed to potentially damaging noise levels, head trauma with loss of consciousness, recurring ear infections, acute/chronic disease that could contribute to hearing loss, ototoxic medications or reports problems including academic difficulties.

CPT code(s): 92551, 92552 or 92587

ICD: V20.2

Modifier: EP Modifier is required in block 24D

Interperiodic Examination – Birth through 20 years

CPT code(s): 99381-99385; 99391-99395

ICD: V70.3

Modifier: EP Modifier is required in block 24D

For vaccine coverage please visit North Carolina Medicaid - Billing Guidelines for Vaccines

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