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Early, Periodic, Screening, Diagnosis, and Treatment (EPSDT) Providers
RE: Rate Increase for EPSDT Periodic Evaluation and Management (E&M) Procedure Codes
Effective July
1, 2025, the Alabama Medicaid Agency (Medicaid) will increase the reimbursement
rates for the following EPSDT Periodic Evaluation and Management (E&M) procedure codes. Please see the article titled EPSDT
Referred – Did You Know? in the January 2024 Provider Insider newsletter for
additional information on how to file claims with the EP modifier or as EPSDT
referred. Additionally, these increases do not impact Alabama
Coordinated Health Network Participation rates or Physician Bump rates.
|
EPSDT
Periodic Procedure Codes
|
|
E & M
Procedure Codes
|
Procedure
Code Description
|
Current
Medicaid Reimbursement Rate
|
New
Medicaid Reimbursement Rate
Effective 07/01/2025
|
|
99381 EP
|
New Patient under 1 year of age
|
$70.00
|
$80.00
|
|
99382 EP
|
New Patient 1 year to 4 years of age
|
$70.00
|
$80.00
|
|
99383 EP
|
New Patient 5 years to 11 years of age
|
$70.00
|
$80.00
|
|
99384 EP
|
New Patient 12 years to 17 years of
age
|
$70.00
|
$80.00
|
|
99385 EP
|
New Patient 18 years to 20 years of
age
|
$70.00
|
$80.00
|
|
99391 EP
|
Established Patient under 1 year
|
$70.00
|
$80.00
|
|
99392 EP
|
Established Patient 1 year to 4 years
of age
|
$70.00
|
$80.00
|
|
99393 EP
|
Established Patient 5 years to 11
years of age
|
$70.00
|
$80.00
|
|
99394 EP
|
Established Patient 12 years to 17
years of age
|
$70.00
|
$80.00
|
|
99395 EP
|
Established Patient 18 years to 20
years of age
|
$70.00
|
$80.00
|
Providers with billing questions should contact the Gainwell Technologies 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 © 2025 American Medical Association and © 2025 American Dental Association (or such other date publication of CPT and
CDT). All rights reserved. Applicable FARS/DFARS apply.