Early and Periodic Screening, Diagnosis, and Treatment Services (EPSDT), Medicaid’s comprehensive and preventive child health program for individuals under the age of 21, includes periodic screening, vision, dental and hearing services. In addition, Medicaid is required to provide any medically necessary health care to correct and ameliorate physical and mental conditions.
EPSDT Specialized Services are medically necessary treatment services for children that are not routinely covered through Virginia Medicaid. The six most commonly requested EPSDT Specialized Services are listed below. This list is not exclusive. To access EPSDT Specialized Services, the medical provider sends an order to an enrolled service provider chosen by the family. The service provider then obtains a service authorization if necessary. The table below identifies who to contact depending on the type of service and the child’s benefit.
Determination of whether a service is medically necessary is made on a case-by-case basis, taking into account a particular child’s needs. Please note that EPSDT cannot cover experimental treatment or treatment which is not determined to be medically necessary.
For questions regarding these or other available specialized services please call (804)786-6134 or email email@example.com. Additional EPSDT information can also be found under the Maternal and Child Health link on the DMAS website at www.dmas.virginia.gov.
Contact information for Managed Care Organizations (MCOs) can be found at www.virginiamanagedcare.com or by calling the Medicaid Managed Care Help Line at 1-800-643-2273.