FIELD 24H- EPSDT/Family Plan [lines 1–6]
The “EPSDT/Family Plan” identifies certain services that may be covered under some state plans.
NUCC INSTRUCTIONS: For reporting of Early & Periodic Screening, Diagnosis, and Treatment (EPSDT) and Family Planning services, refer to specific payer instructions.
EPSDT
When EPSDT services are reported on this claim, identify the status of the referral by entering one of the following reason codes right justified in the shaded area of the field.
The following codes for EPSDT are used in 5010A1:
- AV Available – Not Used (Patient refused referral.)
- S2 Under Treatment (Patient is currently under treatment for referred diagnostic or corrective health problem.)
- ST New Service Requested (Referral to another provider for diagnostic or corrective treatment/scheduled for another appointment with screening provider for diagnostic or corrective treatment for at least one health problem identified during an initial or periodic screening service, not including dental referrals.)
- NU Not Used (Used when no EPSDT patient referral was given.)
Family Planning
When there is a requirement to report this is a Family Planning service, enter Y for “YES” in the unshaded area of the field.
When there is no requirement to report this is a Family Planning service, leave the field blank.
MEDICARE INSTRUCTIONS: Leave blank. Not required by Medicare.
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