Thank you for being a participating Health Partners Plans (HPP) provider. As a healthcare provider, you play a critical role in monitoring children’s growth and development and identifying problems as early as possible. The American Academy of Pediatrics (AAP) recommends that healthcare providers do the following:

• Monitor the child’s development during regular well-child visits.
• Periodically screen children with validated tools at recommended ages to identify any areas of concern that may require a further examination or evaluation.
• Ensure that more comprehensive developmental evaluations are completed if risks are identified.

Well-child visits help monitor the growth and progress of children and young adults through validated screening tools and counseling. Assessing changes in a child’s physical, emotional and behavioral health — with the help of the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program — can help lessen the risk of serious and long-term health issues.

Validated Tools for Developmental Monitoring & Screening
Resources: HPPlans.com/DevelopmentalScreenings
Timeframe: 9 months, 18 months, 30 months

Developmental screening is more in-depth than monitoring and may help identify children with a developmental risk that was not identified during developmental monitoring.

The Pennsylvania Department of Human Services (DHS) and the Pennsylvania EPSDT program requires all Medicaid providers to screen for developmental delays during well-child visits. Providers must document all surveillance (monitoring), screening and referral activities, and must include a copy of the validated development tool used to conduct the screening.

Milestone Tracking
Resources:
     ∙ For providers: https://www.cdc.gov/ncbddd/actearly/hcp/index.html
     ∙ For parents: https://www.cdc.gov/ncbddd/actearly/milestones/index.html
Timeframe: Varies

It is important for clinicians to teach parents and caregivers to recognize developmental milestones. Research has confirmed that parents are reliable sources of information about their child’s development. Parents who are aware of developmental milestones can observe their child and inform their healthcare provider about any concerns they may have about their child’s development. Pediatric healthcare providers can provide parents with milestone checklists to track their child’s milestones at home.

Lead Screenings during Well-Child Visits
Resources: HPPlans.com/Lead
Timeframe: 12 months, 24 months old

In addition to developmental screening, all Health Partners (Medicaid) and KidzPartners (CHIP) members are required to have a lead test completed by 12 months old and again at 24 months old. If a child’s blood lead level is above 3.5 micrograms per deciliter, the CDC recommends intervention through follow-up blood tests and a review of possible sources of contamination, including housing, food, and toys.

Quality Care Plus Program
Resources: HPPlans.com/QCP

If your practice participates in our Quality Care Plus (QCP) primary care incentive program, your incentive payout correlates to the percentage of lead screenings performed in children before their second birthday and percentage of children screened for developmental delays in children 0-3 years of age.

CPT Coding
Provider offices should use CPT codes 96110 and 96127, which are the correct codes for developmental screenings and emotional and behavioral assessments. If you identify issues in children and young adults under age 21, you should utilize the standard assessment tools and include the CPT codes in your claim submissions.

We’re Here to Help
If you have any questions regarding EPSDT, please contact HPP’s Healthy Kids department at 215-967-4690. If your questions are about CPT codes, please contact our Provider Services Helpline at 1-888-991-9023 (M-F, 9:00 a.m.—5:30 p.m.).