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June 2, 2006
 
 
 
MEDICAID INFORMATION RELEASE MA06-17
 
 
TO:                 All Physicians, Osteopaths and Mid-Level Practitioners
 
FROM:           Leslie M. Clement, Deputy Administrator
 
SUBJECT:     EPSDT RATE INCREASES AND EXPANDED COVERAGE FOR ADULT PREVENTIVE MEDICINE SERVICES EFFECTIVE JULY 1, 2006
 
Idaho Medicaid has updated rates and age limitations for EPSDT and Adult Preventive Medicine procedure codes, in support of the Medicaid Modernization Initiative.  Rates for existing EPSDT preventive medicine codes were increased, and additional adult preventive medicine codes became payable to cover well examinations for all Idaho Medicaid participants.  (Prior to July 1, 2006, preventive medicine procedures were only covered for participants up to the age of 21.)
 
Changes to EPSDT and Adult Preventive Medicine Codes
 
Updated reimbursement rates are listed in the table below.  Additionally, the age limitation for codes 99385 and 99395 have been updated to cover adult participants ages 18-39. 
 
Code
SERVICE DESCRIPTION
NEW RATE
 
New Patient Preventive Medicine Exam
 
99381
Infant
$102.83
99382
Child Age 1-4
$115.42
99383
Child Age 5-11
$114.69
99384
Adolescent Age 12-17
$127.91
99385*
Adult Age 18-39 (see above)
$127.91
 
 
 
 
Established Patient Preventive Medicine Exam
 
99391
Infant
$84.99
99392
Child Age 1-4
$97.84
99393
Child Age 5-11
$97.47
99394
Adolescent Age 12-17
$110.43
99395*
Adult Age 18-39 (see above)
$110.79
 
 
 
 
Newborn Care
 
99431
History & Exam/Facility Birth
$85.50
99432
History & Exam/Home Birth
$98.51

 
Addition of Payable Codes for Adult Preventive Medicine Over Age 39
 
The following codes are effective July 1, 2006 to cover well examinations for adult participants over age 39:
 
Code
SERVICE DESCRIPTION
RATE
 
New Patient Preventive Medicine Exam
 
99386*
Adult Age 40-64
$127.91
99387*
Adult Age 65+
$127.91
 
 
 
 
Established Patient Preventive Medicine Exam
 
99396*
Adult Age 40-64
$110.79
99397*
Adult Age 65+
$110.79
 
Billing Instructions
 
*Preventive Medicine procedures billed for participants over age 21 must be billed with diagnosis code V700 or the claim will be denied. Please bill the appropriate procedure for the participant’s age as listed above.  
 
Adult preventive medicine procedures will be limited to one per rolling year. Evaluation and Management procedures will not be paid on the same day as a preventive medicine procedure for participants over age 21.
 
If you have any questions please contact Eric Anderson, Senior Financial Specialist for the Medicaid Office of Reimbursement Policy, at (208) 364-1918.  Thank you for your continued participation in the Idaho Medicaid program.
 
LC/ea/sw