OAR 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.