Early and Periodic Screening Diagnostic and Treatment (EPSDT)
EPSDT Program
EPSDT covers care for those under the age of 21 at no cost to you. EPSDT stands for:
- Early – So problems are treated soon
- Periodic – To set up routine visits
- Screening – To check for a health problem
- Diagnostic – To find a health problem
- Treatment – To care for a problem
Your child’s PCP will work with you to get the care your child needs. EPSDT covers:
- Well-child exams
- Lab testing
- Vision and hearing tests
- Lead screening
- Health info
Your child should have an EPSDT check at:
After that, children should have at least one exam per year.
EPSDT also covers medically necessary care for issues found by an exam. This can be things like glasses and hearing aids.
Set Up an EPSDT Preventive Health Visit With Your Child’s PCP
Preventive health is key to your health. Seeing a PCP on a routine basis helps them find and treat problems early. Care management is also here if you have special health care needs.
Call your PCP to set up an EPSDT visit. Ask for an EPSDT visit when you call. You should have your child’s first exam within 90 days of being with CareSource.
Some services may need a referral from your PCP or prior authorization by us.
Prior Authorization: Approval that may be needed before you get a service. It must be medically necessary for your care. Your provider will get PA for the care you need. PA services are at: www.caresource.com/ga/plans/medicaid/benefits-services/referrals-prior-authorization. You can also call us.
Referral: Your provider will ask for some services before you can get them. They will set this up and give you a note. They will tell you next steps. This can be lab tests, x-rays, or seeing specialists.
Member Services: 1-855-202-0729 (TTY: 711), Monday through Friday 7 a.m. – 7 p.m.