TO: All Providers
RE: Specialist Referrals Not Required by Alabama Medicaid
On June 1, 2023, Alabama Medicaid resumed the EPSDT referral requirement for EPSDT visits. Once
a child has an EPSDT screening, all subsequent visits to other providers for further diagnosis or
treatment must have a written referral (Form 362) from the EPSDT screening provider. Please refer to
Appendix A- Well-Child Checkup (EPSDT) of the Provider Billing Manual for additional information
related to EPSDT services and referrals.
The resumption of the EPSDT referral should not be confused with the removal of the PCP referral
requirement. As of August 1, 2021, Alabama Medicaid no longer require PCP referrals to specialists.
However, some provider offices may require a referral prior to rendering services to Alabama Medicaid
recipients. In this case, the referring provider would need to comply with the rendering provider’s
request.
Medicaid recipients that are in a lock-in status will need a referral from their lock-in provider. If a
Medicaid recipient is in a lock-in status, the lock-in provider will be indicated on the Medicaid recipient’s
eligibility verification from the secure web portal.
For questions regarding referrals, you may contact the Gainwell Provider Assistance Center at 1-800-
688-7989.
The Current Procedural Terminology (CPT) and Current Dental Terminology (CDT) codes descriptors, and other data are copyright © 2022 American Medical Association
and © 2022 American Dental Association (or such other date publication of CPT and CDT). All rights reserved. Applicable FARS/DFARS apply.