Billing for CHDP Services

Billing for Services

For fee-for-service (FFS) physicians, preventive and screening services for children and youth under age 21 years are billed on a CMS-1500 form using appropriate CPT/HCPCS codes. The XX indicator "3" must be also entered in the box 24H (EPSDT/family planning) of the CMS-1500 to indicate that the visit was for preventive and screening services.

For capitated providers, preventive and screening services for children and youth under age 21 must be submitted on an encounter to the participating physician group (PPG) for each visit.

Note that health assessment services are included in payment for the office visit and are not separately payable.