Service feature in Child Health Check-Up (formerly EPSDT)

Child Health Check-Up (CHCUP) is available to every Medicaid-eligible child under age (21). It includes screening (or well-child check-ups), diagnosis and treatment.

To provide Child Health Check-Ups, a provider must be enrolled in Medicaid as a provider with a Category of Service (code 55) for Child Health Check-Ups.

As licensed health care professionals you are aware that performing a blood test is a federal  requirement at specific intervals during the “Child Health Check-Up.” This note is to remind you how  important it is to document the blood tests you are performing in compliance with this federal mandate.  Failure to provide documentation can lead to a federal audit and the requirement to repay Medicaid for fees received.  

The CHCUP schedule listed below is based on the American Academy of Pediatrics, ”Recommendations for Preventive Pediatric Health Care” and Florida Medicaid’s recommendation to include the (7) and (9) year old recipients.

The Child Health Check-Up schedule is:

  Birth or neonatal examination
  (2-4) days for newborns discharged in less than (48) hours after delivery
  By (1) month
  (2) months
  (4) months
  (6) months
  (9) months
  (12) months
  (15) months
  (18) months
  Once per year for (2) through (20) year olds*

The child may enter the periodicity schedule at any time. For example, if a child has an initial screening at age (4), then the next periodic screening is performed at age (5).

* Florida Medicaid recommends check-ups at (7) and (9) years of age for those children at risk.

Vaccines for Children  

The Centers for Disease Control and Prevention (CDC), which provides Vaccines for Children (VFC) funding, has developed strict accountability requirements from the state, local health jurisdictions, and individual providers. Molina Healthcare Providers should be enrolled in the VFC program through their
local health department. State supplied vaccines are provided at no cost to enrolled providers through the local health department. Florida is a “universal vaccine distribution” state. This means no fees can be charged to patients for the vaccines themselves and no child should be denied state supplied vaccines for inability
to pay an administration fee or office visit.

Molina Healthcare follows AHCA billing guidelines for reimbursing a provider’s administration costs. We reimburse per Florida’s fee schedule. Providers must bill state-supplied vaccines with the appropriate procedure codes.

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