Vision and Development screen billing overview

VISION SCREENING

PCPs must perform a subjective vision screening (i.e., by history) at each well child visit. For asymptomatic children 3 years of age and older, an objective screening must occur as indicated on the AAP periodicity schedule. For children of any age, referral to an optometrist or ophthalmologist must be made if there are symptoms or other medical justification (e.g., parent/guardian has suspicions about poor vision in the child). The AAP requires a vision risk assessment at each well child visit. MDHHS requires vision testing at specific well child visits for children 3 years of age and older.

PRESCHOOL

Due to behavior and comprehension ability of children younger than 3 years of age, the standard screening is subjective. An objective screening should begin at 3 years of age. An objective vision screening is accomplished using a standardized screening tool and may be performed on Medicaid eligible preschool-age children each year beginning at 3 years of age through 6 years of age by qualified Local Health Department (LHD) staff.

If the child is uncooperative, the screening should be re-administered within six months.

LHDs may provide objective vision screening services and accept referrals for screening from the PCP and from Head Start agencies. In an effort to promote communication with the child’s medical home, the objective vision screening results must be reported to the child’s PCP. In the event the LHD is unable to report the objective vision screening results to the child’s PCP, the LHD must clearly document why this could not be accomplished. If the LHD receives authorization, the results may be shared with the Head Start agency if that agency was the referral source.


SCHOOL AGE

A subjective vision screening must be performed at each well child visit; an objective screening shall be performed as indicated on the AAP periodicity schedule.



PERIODICITY SCHEDULE FOR VISION SCREENING

A vision screening is to be performed at 3, 4, 5, 6, 8, 10, 12, 15, and 18 years of age. A risk assessment is to be performed, with appropriate action to follow if positive, for newborns and during the ages of:


* 3 to 5 days

* 1 month

* 2 months

* 4 months

* 6 months

* 9 months

* 12 months

* 15 months

* 18 months

* 24 months
* 30 months

* 7 years

* 9 years

* 11 years

* 13 years

* 14 years

* 16 years

* 17 years

* 19 years

* 20 years



 DEVELOPMENTAL/BEHAVIORAL ASSESSMENT

A developmental/behavioral assessment is required at each scheduled EPSDT well child visit from birth through adolescence as recommended by the AAP periodicity schedule. The PCP should screen all children for developmental and behavioral concerns, including engaging in risky behavior, using a validated and standardized screening tool as indicated by the AAP periodicity schedule.

A maximum of three objective standardized screenings may be performed in one day for the same beneficiary by a single provider. (Refer to the Billing & Reimbursement for Professionals Chapter for billing instructions.) If the screening is positive or suspected problems are observed, further evaluation must be completed by the PCP, or the child should be referred for a prompt follow-up assessment to identify any further health needs. The provider may administer additional screenings, surveillance, or assessments as described in the following subsections.


DEVELOPMENTAL SCREENING

A developmental screening using an objective validated and standardized screening tool must be performed following the AAP periodicity schedule at 9, 18 and 30 (or 24) months of age, and during any other preventive health care well child visits when there are parent/guardian and/or provider concerns. Developmental screening may be accomplished by using a validated and standardized developmental screening tool such as the Ages and Stages Questionnaire (ASQ) or Parents’ Evaluation of Developmental Status (PEDS). If the screening is positive, PCPs should further evaluate the child, provide counseling, and refer the child as appropriate.

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