EPSDT Dyslipidemia Screening

According to the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) schedule, Universal Screening for Dyslipidemia should be performed once between the ages of 9-11 and again between the ages of 17-20.

Additional screening may be needed based on any risk factors, history, or symptoms that are present.

Billing

All EPSDT screening services must be reported with the age-appropriate evaluation and management code along with the EP modifier.

• 9 year to 11 year EPSDT visit CPT code is 99383 or 99393
• 17 year to 20 year EPSDT visit CPT code is 99384 or 99394

The CPT code suggested for Dyslipidemia Screening is 80061.                           

Modifier:

• Modifier 90 should be applied when laboratory procedures are performed by a party other than the treating or reporting provider. Use CPT code plus modifier 90 Reference Outside Lab. This modifier is used to indicate that although the provider is reporting the performance of a laboratory test, the actual testing component was a service from laboratory.
• Modifier 52 should be applied for a Screening that may not be completed. If a screening service or component is reported with modifier 52, the provider must complete the screening service or component during the next screening opportunity according to the Periodicity Schedule.

Please note, these codes are not all encompassing and use does not guarantee payment. They are intended as a guide to provide education around appropriate screenings and coding as part of the EPSDT program.

For questions regarding the EPSDT program, please contact EPSDTinfo@HighmarkWholecare.com.

References:

AAP Clinical Report on Lipid Screening in Children | AAFP