Early and Periodic Screening, Diagnostic, and Treatment

The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit provides comprehensive and preventive health care services for children under age 21 who are enrolled in Medicaid. EPSDT is key to ensuring that children and adolescents receive appropriate preventive, dental, mental health and specialty services.

• Early: Assessing and identifying problems early
• Periodic: Checking children's health at periodic, age-appropriate intervals
• Screening: Providing physical, mental, developmental, dental, hearing, vision, and other screening tests to detect potential problems
• Diagnostic: Performing diagnostic tests to follow up when a risk is identified, and
• Treatment: Control, correct or reduce health problems found.

EPSDT Services

States are required to furnish all 1905(a) Medicaid coverable, appropriate, and medically necessary services needed to correct and ameliorate health conditions, based on certain federal guidelines. EPSDT is made up of the following screening, diagnostic, and treatment services:

Screening Services

• Comprehensive health and developmental history
• Comprehensive unclothed physical exam
• Appropriate immunizations (according to the Advisory Committee on Immunization Practices)
• Laboratory tests including lead toxicity screening
• Health Education (anticipatory guidance including child development, healthy lifestyles, and accident and disease prevention)
• Schedules for periodic screening services must be provided at intervals that meet reasonable standards of medical practice. States must consult with recognized medical organizations involved in child health care in developing their schedules. Alternatively, states may elect to use a nationally recognized pediatric periodicity schedule (i.e., Bright Futures). A separate dental periodicity schedule is also required.

Vision & Hearing Services

At a minimum, vision and hearing services include screening, diagnosis and treatment for defects in vision and hearing such as hearing aids and eyeglasses. Vision services must be provided according to a periodicity schedule and at other intervals as medically necessary. For additional information visit the Vision and Hearing Screening Services for Children & Adolescents page.

Dental Services

Covered dental services must, at a minimum, include dental care needed for relief of pain, infection, restoration of teeth, maintenance of dental health (provided at as early an age as necessary), and medically necessary orthodontic services. Each state is required to develop a dental periodicity schedule in consultation with recognized dental organizations involved in child health. Services at more frequent intervals than specified in the periodicity schedule are covered when medically necessary for an individual child. Refer to the Dental page for more information.

Lead Screening

All children enrolled in Medicaid are required to receive blood lead screening tests at 12 and 24 months of age. In addition, any child between the ages of 24 and 72 months with no record of a previous blood lead screening test must receive one. Additional information on Medicaid’s universal blood lead screening requirement can be found on the Lead Screening page.

Immunizations/Vaccines for Children (VFC) Program

All children under age 21 eligible for EPSDT should receive all age-appropriate vaccines as recommended by the Advisory Committee on Immunization Practices. The VFC program provides federally purchased vaccines to children who are enrolled in Medicaid, uninsured, underinsured, or American Indian/Alaska Native. Additional information is available on the Quality of Care Vaccines page.

Other Necessary Health Care Services

States are required to provide any additional 1905(a) services that are coverable under the Federal Medicaid program and found to be medically necessary to treat, correct, or reduce illnesses and conditions discovered regardless of whether the service is covered in a state's Medicaid plan. It is the responsibility of states to determine medical necessity on a case-by-case basis.

Diagnostic Services

When a screening examination indicates the need for further evaluation of an individual's health, diagnostic services must be provided. Necessary referrals should be made without delay and there should be follow-up to ensure the enrollee receives a complete diagnostic evaluation. States should develop quality assurance procedures to assure that comprehensive care is provided.

Treatment

Necessary health care services must be made available for treatment of all physical and mental illnesses or conditions discovered by any screening and diagnostic procedures.

State Program Guidelines

State Medicaid agencies are required to:

• Inform all Medicaid-eligible individuals under age 21 that EPSDT services are available and of the need for age-appropriate immunizations;
• Provide or arrange for the provision of screening services for all children;
• Arrange (directly or through referral) for corrective treatment as determined by child health screenings; and  
• Report EPSDT performance information annually via Form CMS-416.

EPSDT Strategy Guides to Support States with the Medicaid Benefit for Children and Adolescents

CMS developed a set of strategy guides to support states and their partners as they implement the EPSDT benefit. Each strategy guide identifies specific, doable approaches to improve access, utilization and quality of care for children and adolescents enrolled in Medicaid. Examples of state successes are offered along with web-based links to resources, tools and more in-depth information.

The four guides in the series are:

• EPSDT - A Guide for States: Coverage in the Medicaid Benefit for Children and Adolescents
• Keep Kids Smiling: Promoting Oral Health Through the Medicaid Benefit for Children & Adolescents
• Paving the Road to Good Health: Strategies for Increasing Medicaid Adolescent Well-Care Visits
• Making Connections: Strategies for Strengthening Care Coordination in the Medicaid Benefit for Children & Adolescents

EPSDT Data

The Form CMS-416 is used by CMS to collect basic information on State Medicaid and CHIP programs to assess the effectiveness of EPSDT services.

Annually, states must provide CMS with the following information:

1. Number of children provided child health screening service
2. Number of children referred for corrective treatment
3. Number of children receiving dental services
4. State's results in attaining goals set under section 1905(r) of the Social Security Act.

Form CMS-416 and instructions

• CMS-416 Instructions (Updated 2/2024)
• Form CMS-416 (Updated 2/2024)

To report data prior to FFY 2020 (Oct. 1, 2019 – Sept. 30, 2020) or to request a 508-version of the form, please email EPSDT@cms.hhs.gov.

Additional resources for reporting include:

• FFY 2019 Form CMS-416 Data Quality Checklist for States

Annual Reporting Data Files:

• FY 2021 Data (updates as of 05/19/2023)
• FY 2020 Data (updates as of 06/29/2022)
• FY 2019 Data (updates as of 11/12/2020)
• FY 2018 Data (updates as of 11/15/2019)
• FY 2017 Data (update as of 03/12/2019)
• FY 2016 Data (update as of 03/14/2019)
• FY 2015 Data (last update 09/29/16)
• FY 2014 Data (last update 04/28/16)
• FY 2013 Data (last update 10/22/14)
• FY 2012 Data (last update 10/22/14)
• FY 2011 Data (last update 01/07/14)
• FY 2010 Data (last update 11/19/14)
• FY 1995-2009 Data