CPT 99381

CPT Coding Guidelines For Child Health Check Up

CHCUP is the Child Health Checkup Program from medicaid and and used to be called EPSDT (Early and Periodic Screening, Diagnosis and Treatment). CPT 99381, CPT 99382, 99383, 99384 & 99385 can be used to report CHCUP services for new patients. CPT 99391, CPT 99392, CPT 99393, CPT 99394 & CPT 99395 can be used to report CHCUP services for established patients. The coding guidelines and descriptions of the CPT codes can be found underneath.

What Is The Child Health Check Up Program (CHCUP)?

The purpose of the Child Health Check-Up Program is to provide the following services to children from birth through age 20:

  • Comprehensive, preventive, well child care on a regularly scheduled basis;
  • Identification and correction of medical conditions before the conditions become serious and disabling; and
  • An entry into the health care system and access to a medical home.

CPT Codes For Child Health Check Up Services (New Patient)

CPT 99381, CPT 99382, 99383, 99384 & 99385 can be used to report CHCUP services for new patients.

CPT 99381

Description of CPT 99381: Initial comprehensive preventive medicine evaluation and management of an infant, age under 1 year.

CPT 99382

Description of CPT 99382: Initial comprehensive preventive medicine evaluation and management of early child hood, age 1 through 4 years.

CPT 99383

Description of CPT 99383: Initial comprehensive preventive medicine evaluation and management of late childhood, age 5 through 11 years

CPT 99384

Description of CPT 99384: Initial comprehensive preventive medicine evaluation and management of an adolescent, age 12 through 17 years.

CPT 99385

Description of CPT 99385: Initial comprehensive preventive medicine evaluation and management of an 18 through 20 year old.

Modifier EP must be used with CPT 99385 to identify children 18 through 20 years of age. This is an all-inclusive service. No separate billing for required or recommended components is allowed.

CPT Codes For Child Health Check Up Services (Established Patient)

CPT 99391, CPT 99392, CPT 99393, CPT 99394 & CPT 99395 can be used to report CHCUP services for established patients.

CPT 99391

Description of CPT 99391: Periodic comprehensive preventive medicine reevaluation and management of an infant, age under 1 year.

CPT 99392

Description of CPT 99392: Periodic comprehensive preventive medicine reevaluation and management of early childhood, age 1 through 4 years.

CPT 99393

Description of CPT 99393: Periodic comprehensive preventive medicine reevaluation and management of late childhood, age 5 through 11 years.

CPT 99394

Description of CPT 99394: Periodic comprehensive preventive medicine reevaluation and management of an adolescent, age 12 through 17 years.

CPT 99395

Description of CPT 99395: Periodic comprehensive preventive medicine reevaluation and management of an 18 through 20 year old.

Modifier EP must be used with CPT 99395 to identify children 18 through 20 years of age. This is an all-inclusive service. No separate billing for required or recommended components is allowed.

ICD 10 Code To Report CHCUP Services

Description of ICD-10-CM Z00. 129: Encounter for routine child health examination without abnormal findings.

Coding Guidelines

Child Health Check-Ups are performed according to a periodicity schedule that ensures that children have a health screening on a routine basis.

In addition, children may receive Child Health Check-Up Services whenever it is medically necessary or requested by the child or the child’s parent or caregiver.

If a child is diagnosed as having a medical problem, the child is treated for that problem through the applicable Medicaid program, such as physician, dental and therapy services.

Requirements For Child Health Check Up Services

The CHCUP is to provide the following services to services to children from birth through age 20:

  • Health screening evaluation that shall consist of: comprehensive health and developmental history, including assessment of past medical history, developmental history and behavioral health status;
  • Comprehensive unclothed physical examination;
  • Developmental assessment;
  • Nutritional assessment;
  • Appropriate immunizations according to the appropriate Recommended Childhood
  • Immunization Schedule for the United States;
  • Laboratory testing (including blood lead testing);
  • Health education (including anticipatory guidance);
  • Dental screening (including a direct referral to a dentist for Enrollees beginning at three (3) years of age or earlier as indicated);
  • Subsequent examinations by a dentist are recommended every six months or as prescribed by a dentist or other authorized provider.
  • Vision screening, including objective testing as required;
  • Hearing screening, including objective testing as required;
  • Diagnosis and treatment; and referral and follow-up as appropriate.

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