child health check up services

What is CHCUP? What is the purpose of CHCUP? (2021)


Child Health Check Up Services

CHILD HEALTH CHECKUP PROGRAM (CHCUP) – This is Medicaid’s program that used to be called EPSDT – Early and Periodic Screening, Diagnosis and Treatment.

PURPOSE & DESCRIPTION:

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.

CHCHP DESCRIPTION:

What is Child Health Check Up Services? 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.

CHCUP REQUIREMENTS:

CHCUP Components – 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.

CPT codes to report CHCUP services for New patient

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

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

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

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

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

Note:

The EP modifier must be used with Procedure Code 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 to report CHCUP services for Estabilished patient

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

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

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

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

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

Note:

The EP modifier must be used with Procedure Code 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 code to report CHCUP services

V20.2 Routine infant or child health check up

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