EPSDT stands for Early and Periodic Screening, Diagnosis and Treatment. EPSDT is a child health benefit under Medicaid. It is designed to help the physical, mental and developmental health needs of children. The purpose of EPSDT is to find and treat health problems early so that children can have the best health and development possible.

EPSDT is a covered benefit by the federal law that guarantees coverage for medically necessary health care services for Medicaid members under age 21.

Coverage and Requirements

Services must be ordered by the child's physician or another licensed clinician. Prior approval from SCDHHS may be required to verify medical necessity for some services. Covered services:

  • Must be medically necessary to correct or ameliorate a defect, physical or mental illness or a condition that is identified through a screening examination
  • Must be listed in section 1905(a) of the Social Security Act
  • Must not be experimental/investigational, unsafe or considered ineffective
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