Below is the specific language around the use of telemedicine/ telehealth for EPSDT preventative services:
Effective for dates of service on or after March 5, 2020, the use of telemedicine/telehealth to perform clinically appropriate components of Early and Periodic Screening, Diagnostic and Treatment (EPSDT) preventive services for members older than 24 months of age will be allowed. Essential components of an EPSDT preventive service visit that are impossible to perform via telemedicine/telehealth (e.g., a complete physical exam, vision and hearing screenings, fluoride varnish, laboratory tests, and immunizations) can be performed during an in-person interperiodic visit at a later date when limitations on non-emergent clinical care are lessened.
Coding for EPSDT preventive services completed through telemedicine/telehealth and interperiodic visits:
- Telemedicine/telehealth visit: Normal EPSDT preventive services code by age (99381- 99385, 99391-99395) with telehealth modifier (95), reduced services modifier (52), and place of service (02).
- In-person interperiodic visit: Normal EPSDT preventive services code (99391-99395).
The telemedicine/telehealth visit providing partial components of the EPSDT preventive services visit is reimbursed at 75% of the normal rate. The complete in-person interperiodic visit that occurs at a later date will be reimbursed at 100% of the fee on file.
Episodic and sick care (e.g., CPT codes 99212-99215) may be delivered by telemedicine/telehealth to members of all ages, as long as the same standard of care can be met as an in-person visit. For EPSDT preventive services and episodic and sick care, the overall Medicaid telemedicine/telehealth policy applies including, but not limited to, telecommunication system recommendations, originating site, distant site, and reimbursement rates. As always, providers must maintain the usual medical documentation to support reimbursement of the visit.
Guidance for reducing infection risk while conducting in-person well-child visits is available from the Louisiana AAP (https://www.laaap.org/wp-content/uploads/2020/03/Guidance-from- LA-AAP-on-Continuation-of-Well-Child-Visits-During-COVID.pdf) and guidance specific to vaccine administration during the COVID-19 pandemic is available from the Office of Public Health (http://ldh.la.gov/index.cfm/page/3891). Please continue to monitor LDH policies and professional organization clinical guidance, as updates and resources are subject to change as the pandemic response evolves.