Medical, Dental & Pharmacy

Children's Services

Overview

The Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program is a required service under Title XIX of the Social Security Act and applies to all children and youth under age 21 who are enrolled in Medicaid. The goal of EPSDT is to ensure that individual children and adolescents get the health care they need when they need it.

EPSDT includes all covered services and any other necessary health care, diagnostic services, treatment, and other measures to correct or improve birth defects and physical and behavioral health conditions. EPSDT is designed to ensure that children and adolescents get timely care so that health problems are prevented or diagnosed and treated as early as possible. EPSDT allows for timely identification of problems that, if left undiagnosed or untreated, could create greater disabilities or diminish one’s likelihood of achieving future life goals. And EPSDT supports treatment determinations that are made on a case-by-case basis considering the needs of the child or adolescent.

In Minnesota, EPSDT is known as Child and Teen Checkups (C&TC). The purpose of C&TCs is to reduce the effect of childhood health problems by identifying, diagnosing, and treating health problems early, and to encourage the development of good health habits. It is necessary to ensure children and teens get the health care they need when they need it and in the most appropriate setting. 

C&TC screening services are based on the recommendations of the American Academy of Pediatrics (AAP), the Centers for Disease Control and Prevention (CDC), and the United States Preventive Services Task Force (USPSTF). Minnesota Health Care Programs (MHCP) regularly updates the C&TC Schedule of Age-Related Screening Standards (Periodicity Schedule) (DHS-3379) according to Federal requirements of the EPSDT program, State legislation, and the unique needs and epidemiology of Minnesota's eligible population.

States are required to provide an annual report to the Centers for Medicare & Medicaid Services (CMS) that includes the participation rate based on eligible children receiving a C&TC screening service during the Federal fiscal reporting year. Therefore, accurate billing and coding is critical in documenting the screenings that have been provided. This report, as well as more detailed C&TC data, can be found on the Minnesota Department of Human Services (DHS) Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Program Services: Child and Teen Checkups (C&TC) web page.

States are required to follow up on referrals made from results of a C&TC screening to ensure that children and families receive the necessary services to correct or improve health problems. It is important that providers report all referrals from complete C&TC health visit claims using one of the four Health Insurance Portability and Accountability Act (HIPAA)-required referral codes. DHS provides these referral codes through a secure data system that informs local program staff who offer referral assistance to families of children younger than age 11. Refer to the HIPAA Compliant Referral Condition Codes fact sheet for more information.

Every county, Red Lake, Fond du Lac, and White Earth Tribal Nations, and some Integrated Health Partnerships have a C&TC coordinator available to assist those eligible for this benefit. C&TC coordinators help families understand the benefits of preventive care as well as assist with transportation and scheduling. To find a local coordinator, contact DHS at dhs.childteencheckups@state.mn.us. 

Coordination of Preventive Health Care

The C&TC program emphasizes the need to avoid fragmentation of care and the importance of continuity of care in comprehensive health supervision. Providers can help reduce duplication of services by performing a complete, comprehensive C&TC during other preventive health visits, such as the following:

  • Newborn and well-baby checkups
  • School
  • Camp or athletic physicals
  • Routine well care visits
  • Family planning visits
  • Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) visits
  • Head Start physicals
  • Immunizations
  • Initial prenatal visits
  • Early childhood screenings
  • Foster care evaluation and screening

Eligible Providers

To be reimbursed for C&TC screening services, fee-for-service providers must be enrolled as either of the following and have a signed C&TC Provider Agreement Addendum on file with MHCP:

  • An MHCP-enrolled provider; or
  • A C&TC clinic or a facility supervised by a physician that provides screening according to EPSDT

Individual Treating Providers

Eligible treating providers include the following:

  • Nurse practitioners (NPs)
  • Physicians
  • Physician assistants (PAs)
  • Dentists
  • Non-enrolled Public Health nurses approved by the Minnesota Department of Health (MDH) may provide services after completing the three-day C&TC comprehensive screening component training

Other staff may complete certain screening services within their scope of practice as a licensed professional. Refer to the Enrollment with MHCP section of the MHCP Provider Manual for more information about enrolling as an MHCP provider. 

Note: Providers may be eligible to deliver some services under School-Based Community Services. Refer to the School-Based Community Services section of the MHCP Provider Manual to review provider eligibility, covered services, billing guidance, and related resources. 

Facility Types

Eligible facility types include the following:

  • Clinics
    • C&TC
    • Community Health
    • Dental
    • Physicians
    • Public health
    • Public health nursing
    • Rural health
    • Schools 
  • Family planning agencies
  • Federally Qualified Health Centers (FQHCs)
  • Head Start
  • Hospitals
  • Indian Health Services
  • WIC

Eligible Members

Children and youth under age 21 enrolled with PrimeWest Health for Medical Assistance or MinnesotaCare are eligible for C&TC services. Children enrolled in Medical Assistance or MinnesotaCare through a managed care organization (MCO) must receive screening services from their prepaid Minnesota health care program provider. Use the MN–ITS Interactive Eligibility Request to verify a member’s eligibility for this service.

Covered Services – Medical screenings

The C&TC medical screening components include the following:

  • Health education (anticipatory guidance)
  • Physical growth and measurement (height, weight, head circumference, weight for length percentile, and BMI at appropriate ages)
  • Health history, including social drivers of health and nutrition
  • Developmental health
  • Social-emotional or mental health
  • Suicide risk screening
  • Autism spectrum disorder screening
  • Postpartum depression screening
  • Tobacco, alcohol, or drug risk assessment
  • Physical examination (including but not limited to: pulse, respiration, blood pressure, exam of head, eyes, ears, nose, mouth, pharynx, neck, chest, heart, lungs, abdomen, spine, genitals, extremities, joints, muscle tone, skin, and neurological condition)
  • Immunizations and review of immunizations
  • Newborn screening follow-up: blood spot, hearing, and pulse oximetry (critical congenital heart disease) screening
  • Laboratory tests or risk assessment including the following:
    • Blood lead test
    • Hemoglobin or hematocrit screening
    • Hepatitis C virus screening lab test
    • Tuberculosis risk assessment
    • Sexually Transmitted Infection (STI) risk assessment, with lab testing for sexually active youth
    • Human Immunodeficiency Virus (HIV) screening lab test
    • Syphilis screening lab test
    • Dyslipidemia risk assessment
  • Vision screening (visual acuity screening beginning at age 3, plus lens screening beginning at age 5)
  • Hearing screening (addition of 6000 Hz screening for age 11 and over)
  • Oral health, including the following:
    • Fluoride varnish application (FVA) starting at eruption of the first tooth through age 5.
      • FVA is limited to four per 365 days.
    • Silver diamine fluoride (SDF) application, when necessary

 Refer to the Child and Teen Checkups (C&TC) Schedule of Age-Related Screening (Periodicity Schedule) Standards (DHS-3379) for Minnesota’s age-related screening standards schedule details.
 

Foster Care

Children or teens in foster care or out-of-home placement should receive C&TC visits more frequently, as recommended by the American Academy of Pediatrics (AAP). Refer to the AAP Healthy Foster Care America Health Information Form for health visit recommendations and the AAP Foster Care website for additional resources.

Health Education/Anticipatory Guidance

Health education is a required component of screening services and includes anticipatory guidance. Health education and counseling to either parents or guardians and children is required.

Reimbursement for health education and anticipatory guidance is included in the payment of the Evaluation and Management (E&M) code used for a C&TC screening.

For more information on health education and anticipatory guidance, refer to the Child and Teen Checkups Fact Sheets for anticipatory guidance, birth – 10 years and 11 – 20 years.

Preventive counseling is included in the preventive medicine E&M service; do not bill for preventive counseling separately. Bill with CPT codes 99401 – 99404 if the member visit is for counseling only.

Health History

Health history needs to include social drivers of health. For more information about social drivers of health, refer to the Health History and Social Determinants of Health Fact Sheet.

Developmental and Social-Emotional or Mental Health Screenings

Developmental and social-emotional or mental health screenings are C&TC screening components. DHS prefers a Minnesota Developmental Screening Task Force-recommended screening instrument; however, a DHS-accepted screening instrument can also be used. 

For autism screening, review Screening for Autism Spectrum Disorder (ASD) in Toddlers.

Refer to the Developmental and Social-Emotional Screening in Early Childhood or Mental Health Screening, 6-20 Years fact sheets developed by MDH and DHS and the DHS Children’s Mental Health Division Screening web page for information on developmental and social-emotional or mental health screening and recommended instruments.

Currently, no recommended standardized instrument adequately covers both developmental and social-emotional domains. Two separate screening instruments are needed to adequately screen for potential developmental and social-emotional concerns.

The Survey of Well-being of Young Children (SWYC) milestones, the Baby Pediatric Symptom Checklist (BPSC), and the Preschool Pediatric Symptom Checklist (PPSC), are parent report developmental and social-emotional screening tools that are acceptable to the AAP. These tools may be used to meet the developmental and social-emotional screening components when performing a complete C&TC exam in a clinic setting for children under age 5. Refer to the MDH C&TC Developmental and Social-Emotional Screening Recommendations web page and Instruments at a glance for C&TC Clinic Setting.

For settings outside of a medical clinic, refer to Recommended Screening Instruments in the Minnesota Interagency Developmental Screening Task Force section of the MDH website. The Minnesota Developmental Screening Task Force does not recommend the use of the SWYC in screening programs.

Providers engaging in screening must meet the instrument-specific criteria, as outlined by the publisher. Providers using the standardized instruments may include physicians, nurse practitioners, physician assistants, nurses, medical assistants, or other appropriately trained staff.

Maintain required documentation in the child’s health record. Documentation must include, at a minimum, the name of the screening instruments used, the scores, and the anticipatory guidance provided to the parent or caregiver related to the screening results. If the screening results are abnormal, documentation must include how this is being addressed, such as referral to the local school district (directly or via Help Me Grow), appropriate medical specialists, follow-up plan of care, and, when appropriate, a referral to a local community service agency. Review the Referral section of the Developmental and Social-Emotional Screening In Early Childhood or Mental Health Screening (6-20 Years) fact sheet on the MDH website for more information.

Bill developmental and social-emotional or mental health screenings on the same claim as other C&TC services. When using the SWYC for both developmental and social-emotional screenings, record both codes. Use the following CPT codes:

  • CPT code 96110 for a developmental screening with a standardized instrument
  • CPT code 96127 for a social-emotional or mental health screening with a standardized instrument

Providers may bill for both a developmental and a social-emotional or mental health screening on the same date of service on the same claim. However, providers may not bill for more than two developmental screenings and more than two social-emotional and mental health screenings on the same date of service.

When a developmental and social-emotional or mental health screening is provided at other pediatric visits, bill the developmental and social-emotional or mental health screening on the same claim as the other pediatric services.

Suicide Risk Screening

Beginning October 1, 2025, suicide risk screening is a recommended component beginning at age 12. Maintain required documentation in the youth’s health record. At a minimum, documentation must include the name of the screening instrument used and the results. 

  • Use code 96160 when using an appropriate suicide risk screening tool. 
  • Refer to the C&TC Suicide Risk Screening fact sheet for more information. 

Screening for Autism Spectrum Disorder (ASD) in Toddlers

The American Academy of Pediatrics (AAP) and the C&TC Schedule of Age-Related Screening Standards (Periodicity Schedule) (DHS-3379) recommends autism screenings be part of standard 18- and 24-month C&TC exams. Refer to the Autism Spectrum Disorder Screening fact sheet for more information.

When billing for an ASD-specific screening, use a standardized screening instrument according to the guidelines of the developer, such as the Modified Checklist for Autism in Toddlers Revised, with Follow-up (M-CHAT-R/F).

Bill an ASD-specific screening on the same claim as other C&TC services using CPT code 96110 and modifier U1.

When an ASD-specific screening is completed in addition to another developmental screening using two separate standardized screening instruments, bill for the ASD-specific screening and the developmental screening on the C&TC claim using both of the following:

  • CPT code 96110 (for the developmental screening)
  • CPT code 96110 and modifier U1 (for the ASD-specific screening)

Maintain required documentation in the child’s health record. At a minimum, documentation must include the name of the screening instrument(s) used, the score(s), and the anticipatory guidance provided to the parent or caregiver related to the results. If the screening results are atypical, documentation must include a follow-up plan of care including to whom you referred the child and family and any other ways that the atypical screening results are being addressed. It is important to make a referral right away, do not wait.

Autism Spectrum Disorder (ASD) Referrals

Review the Referral and Management section of the Developmental and Social-Emotional Screening in Early Childhood and Autism Spectrum Disorder Screening fact sheets for more information about referrals.

The following are examples of providers or resources to refer children to when they need additional evaluation:

  • Primary care practitioner
  • Medical specialist, such as a developmental pediatrician
  • Mental health professional
  • Comprehensive Multi-Disciplinary Evaluation (CMDE) providers (search “Early Intensive Developmental and Behavioral Intervention” and then “CMDE assessments” in the MHCP Provider Directory)
  • Local school district for educational evaluation (directly or via Help Me Grow)
  • Local community service agency (directly or via Help Me Connect)

You may also offer families screening resources and provide information on expected milestones from either the Help Me Grow or Learn the Signs Act Early websites. Another resource with Minnesota-specific screening, identification, and referral information is First Steps: Pathway to learning, playing and growing, which provides a summary of key developmental milestones that infants and toddlers should be achieving. This resource contains tips, tools, and guidance to help aid a child’s development. It also explains resources available to parents and caregivers who have questions or concerns about their child’s development. This resource is also available in Hmong, Karen, Oromo, Russian, Somali, Spanish, and Vietnamese.

Refer to Next Steps: Pathway to services and supports for a child recently identified with ASD for children with ASD and related conditions. This resource helps parents and caregivers understand options for their child in the year after diagnosis. This resource is available in Hmong, Karen, Oromo, Russian, Somali, Spanish, and Vietnamese.

For community-based early intervention services, refer directly for a comprehensive evaluation or early intervention services using the EIDBI Referral form. Anyone can make a referral, including family.

Visit the Minnesota Autism Resource Portal for more information about ASD.

Postpartum Depression Screening

Postpartum depression screening is covered as a C&TC service or at other pediatric visits. Postpartum depression screenings may also take place telephonically. Suggested screening times are at the 0 to 1-month visit, the 2-month visit, and either the 4-month or 6-month visit; however, providers may perform a screening at any time up to 13 months for any accompanying caregiver. PrimeWest Health allows up to six postpartum depression screenings for a mother per child under 24 months of age.

Use one of the following standardized screening instruments:

Providers that meet the instrument-specific criteria for administering the screening tool, as outlined by the publisher, may perform postpartum depression screenings. Depending on the tool, this may include physicians, nurse practitioners, physician assistants, nurses, medical assistants, or other appropriately trained staff.

When documenting postpartum depression screening services, record the name of the completed screening instrument and document that it was performed as a “risk assessment” in the child's or mother's medical record.

Providers are not required to include the screening score results or a copy of the screening instrument in the child’s record. Providers may give the mother a paper copy of the screening instrument to bring with her to a referral appointment or destroy it if she does not want it. For more information on postpartum depression screening, referral, and documentation, refer to the MDH Postpartum Depression – Information for Health Professionals web page and Postpartum Depression Screening FACT Sheet. There are also additional tools located on the MDH Depression or Anxiety During and After Pregnancy Brochure and Postpartum Wellbeing Plan web page. 

Refer to the DHS Children's Mental Health Screening web page on the relationship between postpartum depression and children’s developmental, social-emotional, and mental health.

Bill for the postpartum depression screening only when using one of the standardized screening instruments. When billing for a postpartum depression screening, ensure the following criteria are met:

Children

  • Use CPT code 96161
  • Use the child’s PrimeWest Health member ID number
  • The service must be performed in-person
  • There is a limit of 6 screenings in 24 months
  • Bill on the same claim as the C&TC screening or other pediatric visit
  • Bill on the same date as a child’s developmental screening (96110) or a social-emotional screening (96127). The NCCI procedure-to-procedure (PTP) edit pairs immunization administration codes (90460, 90461, 90471 – 90474) with postpartum depression screening. You may receive the NCCI edit when submitting claims for postpartum depression screening with CPT code 96161. These edits have a Correct Coding Modifier Indicator of “1” and, therefore, will bypass the PTP edit if you correctly add a PTP-associated modifier. Refer to the DHS Minnesota National Correct Coding Initiative (NCCI) web page for information about modifiers.

Mothers

  • Use CPT code 96127 with modifier HD
  • Use the mother’s PrimeWest Health member ID number
  • The service can be performed in-person or via telephone
  • There are no limits to the number of screenings that may be performed

Tobacco, Alcohol, or Drug Use Risk Assessment

Risk assessment for tobacco, alcohol, and drug use is required for ages 11 – 20 years, followed by appropriate action. For more information, including recommended risk assessment or screening tools, refer to the Tobacco, Alcohol or Drug Use Risk Assessment Fact Sheet.

Resources for adolescent health include the following:

Reimbursement for this assessment using a standardized tool is included in the payment of the Evaluation and Management (E&M) code used for a C&TC screening visit.

Immunization and Vaccinations

Review the immunization status of a child, teen, or young adult compared to the current Recommended Childhood and Adolescent Immunization Schedule from the Advisory Committee on Immunization Practices (ACIP). ACIP is part of the Centers for Disease Control and Prevention (CDC) and provides current recommendations for vaccine administration, schedules of periodicity, and appropriate dosage and contraindications. Refer to the CDC's Immunization Schedules web page.

State law requires all providers who administer pediatric vaccines to enroll in the Minnesota Vaccines for Children (MnVFC) program. MDH administers MnVFC for PrimeWest Health members ages 1 through 18 to provide most pediatric vaccines to participating providers at no cost. Providers must obtain vaccines through MnVFC whenever available.

PrimeWest Health covers flu vaccines and other recommended vaccinations for adults ages 19 or over.

When billing for immunizations or vaccinations administered during a C&TC screening, enter the correct immunization or vaccination code(s) with the SL modifier when applicable, and add the correct administration code(s) to the C&TC claim. Refer to Immunizations and Vaccinations for details on coding and billing criteria. All immunizations are part of the C&TC bundled payment rate. 

Vaccine Counseling

Stand-alone vaccine counseling visits are covered when provided to children and youth under age 21. Providers may counsel for standard pediatric vaccines, including for COVID-19. Counseling may be provided either in person or via telehealth. Providers billing for counseling services must be able to administer the vaccine for which they are counseling. Billable stand-alone vaccine counseling visits do not replace immunization review and administration as required during a complete C&TC visit. Vaccine counseling visits are only billable when done outside of C&TC visits. Review the Immunizations and Vaccinations section of the MHCP Provider Manual for more information.

Stand-alone vaccine counseling visits codes

Code Explanation
G0312 Immunization counseling by a physician or other qualified health care professional when vaccines are not administered on the same date of service for ages under 21, 5 – 15 minutes. (This code is used for Medicaid billing purposes.)
G0313 Immunization counseling by a physician or other qualified health care professional when vaccines are not administered on the same date of service for ages under 21, 16 – 30 minutes. (This code is used for Medicaid billing purposes.)
G0314 Immunization counseling by a physician or other qualified health care professional for COVID-19, ages under 21, 16 – 30 minutes. (This code is used for the Medicaid Early and Periodic Screening, Diagnostic, and Treatment Benefit [EPSDT].)
G0315 Immunization counseling by a physician or other qualified health care professional for COVID-19, ages under 21, 5 – 15 minutes. (This code is used for the Medicaid Early and Periodic Screening, Diagnostic, and Treatment Benefit [EPSDT].)

Immunization and Vaccinations Resources

Refer to the following documents and websites for more information:

Laboratory Tests or Risk Assessment

For information about billing for lab services, refer to Laboratory/Pathology Services section.

PrimeWest Health covers venipuncture and capillary specimen collection and handling.

A Clinical Laboratory Improvement Amendments (CLIA)-certified lab must perform and bill for most lab services.

If a provider has a CLIA-certified lab on site and lab services are provided on site, the CPT code for the lab service may be included in the C&TC visit claim. Payment for lab services is in addition to the C&TC bundled rate. If a provider refers members off site to a CLIA-certified lab for lab tests or screenings that are required or part of a C&TC health visit, the off-site lab bills for the lab test(s), not the provider. That lab test will not be included on the C&TC health visit claim.

If a required lab service was not done at a C&TC visit, do not include it on the C&TC visit claim. Include documentation in the medical record with the date and results of any required lab screenings or test that the C&TC provider or another provider performed within the required age range.

Document in the medical record if a required lab screening or test was not done during the required age range C&TC visit due to the child, adolescent, or parent declining the test or being uncooperative. Attempt the screening or test again in the future.

Blood Lead Test

All children enrolled in Medical Assistance are required to receive blood lead tests at ages 12 months and 24 months. Any child between ages 24 months and 72 months with no record of a previous blood lead test must receive one blood lead test during that age range. Completion of a risk assessment questionnaire does not meet the Medical Assistance requirement. The Medical Assistance requirement is met only when the two blood lead tests (12 and 24 months or a catch-up blood lead test) are conducted. Lead testing can occur at other times within the ranges that are indicated on the Schedule of Age-Related Screening Standards (Periodicity Schedule) (DHS-3379) and when medically indicated. A blood lead test done between 9 and 15 months can fulfill the 12-month screening requirement. A blood lead test completed for a child between 18 months and 24 months can fulfill the 24-month screening requirement.

When billing a blood lead test, use the correct CPT code for the lead test.

Refer to the following documents and websites for more blood lead resources:

Hematocrit or Hemoglobin Screening

Hemoglobin (Hb) or hematocrit (Hct) screening is required as part of a C&TC visit at the following ages for diagnosis and prevention of iron deficiency and iron-deficiency anemia:

  • One baseline Hb or Hct screening is required between ages 9 and 15 months of age.
  • One Hb or Hct screening is required between ages 12 and 20 for all menstruating youth

For more information, including documentation of results and follow-up, refer to the C&TC Hemoglobin or Hematocrit Fact Sheet.

Hepatitis C Screening

Screen for Hepatitis C Virus (HCV) infection using a Food and Drug Administration (FDA)-approved anti-HCV laboratory test. This is recommended once for young adults ages 18 and over. A licensed health care provider (physician, nurse practitioner, physician assistant) must interpret the results of the HCV screening and ensure appropriate follow-up testing if needed. Document that the HCV lab test was complete, test results, and any needed treatment or follow up.

For more information, refer to the C&TC Hepatitis C Virus (HCV) Screening Fact Sheet.

Tuberculosis (TB) Risk Assessment

Complete a risk assessment followed by appropriate action for children ages 1,6,12, and 24 months and annually beginning at age 3 for their risk of exposure to TB. 

High-risk children include those in the following groups:

  • Have had recent close contact with people with infectious TB disease
  • Foreign-born children and children with foreign-born parents from high-prevalence areas
  • Have traveled to areas with endemic TB
  • Children with (or those children in households with) socioeconomic risk factors such as homelessness, living in shelters, or incarceration. Screen any high-risk person who has not received TB testing previously.

TB testing is not mandatory but is a covered service if clinical documentation supports the medical need for the test. When performing TB testing during a C&TC screening, bill with the appropriate CPT code on the C&TC screening claim. For more information, review the C&TC TB Screening Fact Sheet and the Pediatric TB Risk Assessment Tool.

Sexually Transmitted Infection (STI) Risk Assessment and Human Immunodeficiency Virus (HIV) Screening Lab Test

Beginning no later than age 11, assess all youth for risk of sexually transmitted infections (STIs) at each C&TC well visit.

Universal HIV screening (offering HIV blood testing to all youth, regardless of risk factors) is required at least once between ages 15 and 18, as recommended by the American Academy of Pediatrics (AAP) and Centers for Disease Control and Prevention (CDC). Refer to the MDH C&TC STI Risk Assessment fact sheet and C&TC HIV Screening fact sheet for more information, including appropriate documentation of confidential screening test results in medical records. Providers may screen for STIs without parental knowledge or consent. If the youth declines the HIV test, or if their HIV status is already known, document the reason that the HIV blood test was not done. Youth who have risk factors for HIV exposure should be tested at least annually per MN Stat. 144.343.

Resources for adolescent health include the following:

Dyslipidemia Risk Assessment

A risk assessment is required for children at the ages indicated on Schedule of Age-Related Screening Standards (Periodicity Schedule) (DHS-3379). For risk assessment guidelines, refer to the Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents: Summary Report. For more information, refer to the Dyslipidemia Risk Assessment Fact Sheet

Vision Screening

A vision risk assessment is required for children under age 3, followed by appropriate action. Provide distance visual acuity screening beginning at age 3. Add near visual acuity (plus lens) screening beginning at age 5 for children who pass their distance screening and do not already have corrective lenses. Use a wall chart at a 10-foot distance.

Starting at age 11, vision screening must be done once during each of the age ranges as indicated on the Periodicity Schedule (DHS-3379).

Refer to the MDH Vision Screening web page for detailed procedures, including for when a child wears prescription lenses and is under the care of an eye professional, and equipment for visual acuity screening for recommended wall charts and equipment. Instrument-based vision screening may be used as an alternative to wall charts for children ages 3 – 5 who are unable or unwilling to cooperate with routine vision screening.

For more information, refer to the Vision Screening Fact Sheet.

Bill instrument-based vision screening using CPT code 99174 or 99177.

Hearing Screening

Provide hearing risk assessment at all C&TC visits up to age 3 or until pure tone audiometry can be performed. Providers must review newborn hearing screening results at the initial newborn C&TC visits. Pure tone audiometry screening is recommended beginning at age 3 and required starting at age 4. 

Beginning at age 11, the addition of 6000 Hz at 20 dB to hearing screening is required to screen for noise-induced hearing loss once during each of the age ranges as indicated on the Periodicity Schedule (DHS-3379). Refer to Hearing Screening for detailed procedures and instrument recommendations. For more information, refer to the Hearing Screening Fact Sheet.

Oral Health Screening by a C&TC Medical Provider

The C&TC oral health screening components include the following:

  • Oral health history
  • Clinical open- mouth assessment
  • Topical fluoride mandatory at eruption of first tooth through age 5
  • Fluoride supplementation (as indicated by clinical findings)
  • Silver Diamine Fluoride (as indicated by clinical findings) 
  • Anticipatory guidance or counseling
  • Transition to adult care
  • Counseling on the following:
    • Oral hygiene
    • Dietary
    • Injury prevention and mouth guard recommendations
    • Non-nutritive habits
    • Speech and language development
    • Substance abuse
    • Intraoral or perioral piercing

Refer to the Schedule of Age-Related Dental Standards (C&TC Dental Periodicity Schedule) (DHS-5544) for Minnesota’s age-related dental standards schedule details. Refer to the American Academy of Pediatric Dentistry Guideline on Periodicity of Examination, Preventive Dental Services, Anticipatory Guidance/Counseling, and Oral Treatments for Infants, Children, and Adolescents for more information.

For details on dental benefit coverage policy, refer to the Dental Services section.

Primary care provider requirements include the following:

  • Provide an oral health exam, anticipatory guidance, and education for children and their families at every C&TC screening. Refer to the Oral Health Screening Fact Sheet for more information.
  • Verbally refer children to dentists at the time of the eruption of the first tooth or no later than age 12 months and every visit thereafter.

Oral Health (Including Fluoride Varnish Application [FVA] and Silver Diamine Fluoride [SDF])

Fluoride Varnish Application (FVA)

FVA is required for infants upon eruption of the first tooth or no later than age 12 months at each C&TC visit through age 5. FVA may be applied for children age 6 and over based on their risk factors for dental caries. An oral health risk assessment (refer to the American Academy of Pediatrics Oral Health Risk Assessment Tool) can be used to determine need for oral fluoride supplementation. Staff applying fluoride varnish must successfully complete an approved FVA training course. The following types of trained staff may perform FVA:

  • Physicians
  • Physician assistants
  • Nurse practitioners
  • Nurses
  • Clinical staff under the direct supervision of a physician or other qualified health care professional
  • Other licensed or certified health care professionals in a community setting if under the direct supervision of a treating physician (or other qualified health care professional) or dentist

Obtain informed consent for this procedure, either verbally or in writing. Document that you obtained verbal consent, including discussion of benefits and risks of FVA, with each application. Alternatively, a written consent signed by the parent or guardian is valid for up to one year.

For more information on FVA by primary care and other non-dental providers, refer to Fluoride varnish in the Child and Teen Checkups (C&TC) setting and the Oral Health Fact Sheet on the MDH C&TC web pages and the National Maternal and Child Oral Health Resource Center.

FVA primary provider billing

  • Use CPT code 99188: Primary care providers (physicians or other qualified health care professionals) and trained clinical staff.
  • Primary care providers bill FVA on the same claim as the other C&TC services. MHCP reimbursement rate is per procedure (not per tooth). The payment for FVA is in addition to the C&TC “bundled rate” for a complete C&TC visit.
  • When providing FVA at other pediatric visits, bill FVA on the same claim as the other pediatric services.
  • FVA is limited to four per 365 days.

FVA Head Start, WIC, and public health agency billing

  • Use CPT code 99188: Trained licensed or certified health care professionals in a community setting under the direct supervision of a treating physician or other qualified health care professional.
  • Use CDT code D1206: Trained licensed or certified health care professionals in a community setting under the direct supervision of a treating dentist.

Silver Diamine Fluoride (SDF)

The American Medical Association (AMA) approved a code for health care professionals to receive reimbursement for the application of SDF to arrest dental caries lesions without the provision of restorative care. The application of ADF in the pediatric medical home is new and training considerations are evolving. The AAP recommends one-on-one training from dental professionals. Providers may apply this solution to a tooth or teeth where there is a visible need identified during the open-mouth exam at a C&TC visit. Obtain informed consent and provide SDF education. Refer to Silver Diamine Fluoride (SDF) Application in the Pediatric Medical Setting for more information. 

  • Where there is visible need identified during the open-mouth exam at a C&TC visit, providers may apply this solution to a tooth or teeth. 
  • Obtain informed consent and provide SDF education

SDF Primary Care Provider Billing

  • Use CPT code 0792T: Primary care providers (physician or other qualified health care professionals) and trained clinical staff
  • Primary care providers bill SDF on the same claim as the other C&TC services. MHCP reimbursement rate is per tooth with a given tooth number billed once per six months. There is no limit on the number of teeth that may be treated per day. 
  • The payment for SDF, when applied during a C&TC visit, is in addition to the bundled rate. 

Refer to the Non-Dental Health Providers section of the MHCP Provider Manual for specific billing instructions or for more information.

Other Covered Services

The following services are also covered:

  • Interperiodic or interim screenings may be done as medically necessary and are reimbursable as a C&TC screening if all component requirements are met
  • Additional screening services or specific screening components may be provided at other intervals as medically indicated
  • Diagnosis and treatment of health conditions determined to be medically necessary
  • Most services are covered even if services are not covered for adults

The Minnesota Department of Human Services (DHS) contracts with single and multi-county community health boards (CHBs) and Tribal governments to provide C&TC administrative services that include outreach and follow-up activities to enrolled families, young adults, and providers. For more information on these services, refer to the Child and Teen Checkups (C&TC) Tribal and County Administrative Services Contracts section of the MHCP Provider Manual.

 

PW_11-18_479
Updated_04/17/2026