Or. Admin. Code § 410-151-0004 - Screening Exams

(1) Periodic EPSDT screening exams shall be provided in accordance with the Bright Futures Periodicity Schedule (https://downloads.aap.org/AAP/PDF/periodicity_schedule.pdf) and must include:

(a) A comprehensive health and developmental history including assessment of both behavioral health and physical health development;

(b) Assessment of nutritional status;

(c) Comprehensive unclothed physical exam including inspection of teeth and gums;

(d) Appropriate immunizations;

(e) Lead testing as required by OAR 410-151-0040;

(f) Other appropriate laboratory tests (including but not limited to anemia test and sickle cell test) based on age and EPSDT Beneficiary risk;

(g) Health education including anticipatory guidance; and

(h) Appropriate hearing and vision screening.

(2) EPSDT providers may bill for both lab and non-lab services using the appropriate Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes. Immunizations must be billed according to the guidelines listed in OAR 410-130-0255;

(3) Inter-periodic EPSDT screening exams are any EPSDT Medically Necessary and EPSDT Medically Appropriate (or EPSDT Dentally Appropriate) encounters with a physician or other licensed practitioner of the healing arts within their scope of practice under State law. Inter-periodic EPSDT exams may occur at any time and may be warranted when the EPSDT Beneficiary has been ill or has experienced a change in health or development.

Notes

Or. Admin. Code § 410-151-0004

DMAP 97-2023, adopt filed 12/27/2023, effective 1/1/2024; DMAP 114-2024, minor correction filed 07/19/2024, effective 7/19/2024

Statutory/Other Authority: ORS 413.042

Statutes/Other Implemented: ORS 414.025, 414.065 & 414.150