Home Forums Discussions Coding and Billing Please help me understand EPSDT codes-Florida-Staywell

Can someone PLEASE help me understand when and how to properly use the EPSDT codes when billing for well visits for my Staywell patients?? I believe I was given incorrect information by the person prior to myself regarding the use of these codes and now Staywell wants a lot of money back from my provider due to inappropriate billing of those codes. Please...help...

Thanks!!

what codes have you used.
did staywell mention what codes were used wrongly, or if some specific codes were missing

There are a couple of possibilities. Are you paper billing or submitting claims on their web site. The codes are usually 2 letter codes and vary from insurance co to insurance co. If no treatments or referrals were done at the well child check, the code for " no refferals done" or "available, but mot used" should be used. If the patient has a sick code associated with the well child check and is being treated, the code for "under treatment" should be used. If a sick child is encountered for the well child check that needs a referral the code for "referral done or referred to other provider" needs to be used. I am sorry, I do not know the codes off hand.
If you are doing paper billing the codes are usually in the 24 H box. Sometimes the codes are printed in large font and the scanner of the ins. co reads them wrong.