North Carolina Medicaid Preventive Exam & Screening Services
Regular Periodic Examination – Birth through 20 years
Here is the Medicaid vision for North Carolina:
CPT code(s): CPT 99381-9985; CPT 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): CPT 92551, CPT 92552 or CPT 92587
ICD: V20.2
Modifier: EP Modifier is required in block 24D
Interperiodic Examination – Birth through 20 years
CPT code(s): CPT 99381-99385; CPT 99391-99395
ICD: V70
Modifier: EP Modifier is required in block 24D
For vaccine coverage please visit North Carolina Medicaid – Billing Guidelines for Vaccines