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TO:    All EPSDT Providers

RE:   Rate Change for EPSDT Interperiodic Evaluation and Management (E&M) Procedure Codes

Effective for dates of service on and after October 1, 2023, there will be a rate change for the below listed EPSDT Interperiodic Evaluation and Management (E&M) procedure codes with the EP modifier. These E&M codes should be used by participating EPSDT providers when billing interperiodic screenings. Filing these codes with the EP modifier is vitally important so that this visit will not count towards the annual physician office limit for Medicaid recipients under the age of 21. Please refer to Appendix A of the Provider Billing Manual for additional information on how to file claims with the EP modifier.

NOTE: Please refer to the article titled EPSDT Referred – Did You Know? in the July 2023 Provider Insider newsletter for additional information on how to file EPSDT referred services. Additionally, these increases do not impact Alabama Coordinated Health Network (ACHN) or Physician Bump rates.

Providers with billing questions should contact the Gainwell Technology Provider Assistance Center at

1-800-688-7989.

The Current Procedural Terminology (CPT) and Current Dental Terminology (CDT) codes descriptors, and other data are copyright © 2023 American Medical Association and © 2023 American Dental Association (or such other date publication of CPT and CDT). All rights reserved. Applicable FARS/DFARS apply.