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Find health problems early
Early and Periodic Screening, Diagnostic and Treatment (EPSDT) is a Health First Colorado program (Colorado’s Medicaid Program) that covers prevention, diagnostic and treatment services for members age 20 and under and pregnant people. This program is set up to find health problems early. The program goal is for children to get the physical, mental, vision, hearing and dental care they need for their health. Your child can get these services at no cost to you.
Services include:
- Well Child Check-Ups
- Immunizations
- Vision Screening/Eyeglasses
- Hearing Screening
Additional Information
EPSDT services that require a Primary Care Physician (PCP) referral and/or Prior Authorization Request (PAR):
- Speech (PCP Referral)
- Physical Therapy/Occupational Therapy (PCP Referral)
- Home Health (PCP Referral and PAR)
- Substance Use Disorders Treatment (PCP Referral and PAR)
The Bright Futures Recommendations for Preventive Pediatric Health Care periodicity schedule is a list of needed care and how often your child needs that care. For additional information visit the Colorado Department of Health Care Policy & Financing website.
0 to 15 months
- Well child/physical - 8 visits
- Dental - Every 6 months by age 1 or when first tooth breaks
- Hearing - 1 check-up in hospital (at birth); 2 check-ups
- Vision - 1 check-up
18 months to 2 years
-
Well child/physical - 3 visits
- Dental - Every 6 months
- Hearing - 1 check-up after each middle ear effusion
- Vision - 1 check-up at 2 years of age
3 to 20 years
-
Well child/physical - 1 visit per year
- Dental - Every 6 months
- Hearing - 1 check-up at ages 4-6, 8 and 10
- Vision - 1 check-up per year from ages 3-8; 1 check-up every 2 years until age 20
In addition, children that have not had Lead Testing need to get one at 12 and 24 months or between the ages of 36 and 72 months.
You can get these services through your PCP within 30 days of calling for an appointment. Your PCP may refer you to other special services available at Denver Health. EPSDT screening services do not need approval from Denver Health Medicaid Choice (DHMC). Diagnostic services as provided when screening suggests more evaluation or treatment is needed. Most medically necessary (least costly, effective, acceptable medical practice) services needed to treat, correct or prevent illness and condition found by screening or diagnostic tests are covered, and DHMC will not put limits (such as the number of visits allowed) on EPSDT services. Maintenance services may also be covered when needed.
There are some services not covered for EPSDT members. For a full listing please consult your DHMC Medicaid Choice handbook.
Some EPSDT services are not covered by DHMC but are still a benefit to you through Colorado Access. This kind of care is called a "wrap-around" benefit. Please see the wrap-around benefit section of the DHMC Medicaid Choice handbook for more information.
Most EPSDT services will be available within Denver Health. Your doctor may also refer you to services outside Denver Health.
The DHMP Care Management Team is available to help Providers connect to services by calling (303) 602-2184. Care Management can also support families of children enrolled in Medicaid Choice and CHP+ (ages birth through 20) by assisting with Medicaid and CHP+ resources, guiding families to appropriately use Medicaid and CHP+ benefits, assistance finding a Medicaid dentist and coordination of transportation through the non-emergent medical transportation vendor, Intelliride (303) 398-2155.
For more information please reference Early and Periodic Screening, Diagnostic and Treatment (EPSDT).