Child and Teen Checkups (C&TC) is the name for Minnesota’s Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program, a required service under Title XIX of the Social Security Act. C&TC is a comprehensive child health program provided to children and teens (newborn through the age of 20 years) enrolled in Medical Assistance (MA) or MinnesotaCare. The purpose of the program is to reduce the impact of childhood health problems by identifying, diagnosing, and treating health problems early, and to encourage the development of good health habits.
The federal Centers for Medicare & Medicaid Services (CMS) has set a goal for states to have an 80% participation rate in C&TC screening services. Federal law requires states to maintain an 80% participation rate in the C&TC screenings. This participation rate is based on eligible children receiving a C&TC screening service during the reporting year. As Minnesota works toward reaching the 80% participation rate goal, accurate billing and coding is critical in documenting the screenings that have been provided.
States are also required to follow up on referrals made as a result of a C&TC screening to assure that children and families receive the necessary services to correct or improve health problems. It is important that providers report all referrals on C&TC claims using one of the four HIPAA required referral codes.
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 substituting a C&TC screening service (when appropriate) for other preventive health care visits, such as:
To be reimbursed for C&TC screening services, fee-for-service C&TC screening providers must be enrolled as either of the following:
Eligible individual providers include the following:
Staff eligible to provide some components under supervision of a physician or dentist includes the following:
Eligible facility types include the following:
Some providers listed can only complete certain components that are within their scope of practice as a licensed professional. For more information about enrolling as an MHCP provider, refer to Requirements for Providers. Use this MHCP Provider Manual in conjunction with the DHS C&TC Provider Guide (DHS-4212) (PDF).
Children and teens, newborn through the age of 20 years, enrolled in Medical Assistance (MA) or MinnesotaCare are eligible for C&TC services. Children enrolled in MA or MinnesotaCare through a managed care organization (MCO) must receive screening services from their Prepaid Minnesota Healthcare Program provider.
Use MN–ITS Interactive Eligibility Request to verify a recipient’s eligibility for this service.
Note: Urinalysis is no longer required.
Refer to the Schedule of Age-Related Screening Standards (C&TC Screening Component Periodicity Schedule) (DHS-3379) (PDF) for Minnesota’s age-related screening standards schedule details. Refer to the DHS C&TC Provider Guide (DHS-4212) (PDF) for more information on screening components.
The C&TC dental screening components include the following:
Refer to the Schedule of Age-Related Dental Standards (C&TC Dental Periodicity Schedule) (DHS-5544) (PDF) 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 Treatment for Infants, Children, and Adolescents and the Dental Health FACT Sheet for additional information.
For details on dental benefit coverage policy, refer to the Dental Services section of this manual.
Primary Care Provider Requirements
Requirements include the following:
A blood lead test at ages 12 and 24 months is a federally required component of C&TC. Research indicates that MA and MinnesotaCare children are at greater risk of lead poisoning. Lead testing can occur at other times within the ranges that are indicated on the Schedule of Age-Related Screening Standards (C&TC Screening Component Periodicity Schedule) (DHS-3379) (PDF) and when medically indicated. A blood lead test done between ages 9 and 15 months can fulfill the 12-month screening requirement. A blood lead test completed for a child between ages 16 months and 30 months can fulfill the 24-month screening requirement.
When billing a blood lead test use the correct CPT code for the lead test. Venipuncture and capillary specimen collection and handling are covered services.
A CLIA certified lab must perform and bill for lab services.
Blood Lead Resources
Refer to the following documents and websites for more information:
All children and adolescents should be evaluated for their risk of exposure to TB. High-risk children include those in the following groups:
TB testing is recommended for high-risk children and adolescents only, either by tuberculin skin test (TST) or TB blood test. 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.
Developmental and social-emotional or mental health screenings are a C&TC screening component. To receive additional reimbursement for a developmental and social-emotional or mental health screening, use a standardized screening instrument.
Refer to Developmental and Social-Emotional Screening of Young Children (0-5 years of age) in Minnesota for information about screening, recommendations and resources. Refer to the instruments the Minnesota Interagency Developmental Screening Task Force recommends in the Recommended Instruments section of this website. The website also has information about some well-known instruments that the Task Force does not currently recommend.
Refer to the Mental Health Screening (6-21 years) FACT Sheet for a list of instruments the DHS Children’s Mental Health Division and MDH recommend (mental health screening is provided for children ages 6-21, instead of social-emotional screening).
For more information on developmental and social-emotional or mental health screening and recommended instruments, refer to the DHS Children’s Mental Health Division Screening web page and the Social-Emotional Screening (0-5 years) FACT Sheet developed by MDH and DHS.
To receive reimbursement for developmental and social-emotional or mental health screenings, use screening instruments recommended by the Minnesota Interagency Developmental Screening Task Force or, in the case of mental health screening, instruments recommended by the DHS Children’s Mental Health Division. Without the use of a standardized screening instrument, reimbursement for these screenings is included in the payment of the evaluation and management (E&M) code used for a C&TC visit.
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.
Currently, no recommended standardized instrument adequately covers both developmental and social-emotional or mental health screening domains. Two separate screening instruments are needed to adequately screen for potential developmental and social-emotional or mental health concerns.
Maintain required documentation in the child’s health record. Documentation must include, at a minimum, the name of the screening instrument(s) used, the score(s), 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. For more information, see the Referral section of the Developmental and Social-Emotional Screening of Young Children (0-5 years of age) in MDH.
Bill developmental and social-emotional or mental health screenings on the same claim as other C&TC services. Use the following CPT codes:
You 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, you 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.
Providers are encouraged to provide an ASD-specific screening only after they have used an approved developmental and social-emotional or mental health-screening instrument during the last year.
When billing for an ASD specific screening, use a standardized screening instrument according to the guidelines of the developer. Without the use of a standardized screening instrument, reimbursement for ASD-specific screening is included in the payment of the E&M code used for the C&TC visit.
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 one of the following:
You must use the U1 modifier for CPT code 96110 in billing for ASD-specific screening for dates of service beginning Jan. 1, 2016.
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 abnormal, documentation must include a follow-up plan of care including to whom you referred the child and family, as well as any other ways that abnormal screening results are being addressed.
For more information on referrals, see the Referral section of the Developmental and Social-Emotional Screening of Young Children (0-5 years of age) on the MDH website.
The following are examples of providers or resources to refer children to when they need additional evaluation:
For more information about autism spectrum disorders, see the Minnesota Department of Health (MDH) Autism or the Minnesota Department of Human Services (DHS) Children with autism spectrum disorders web pages and the Early Intensive Developmental and Behavioral Intervention (EIDBI) section of the MHCP Provider Manual.
Maternal depression screening is covered as a C&TC service or at other pediatric visits. 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 do screening any time up to 13 months.
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 maternal depression screenings. Depending on the tool, this may include physicians, nurse practitioners, physician assistants, nurses, medical assistants or other appropriately trained staff.
MHCP allows up to six maternal depression screenings for a mother for each child she has who is less than 13 months old. For documenting maternal depression screening service, record the name of the completed screening instrument and that you performed the screening as a “risk assessment” in the child’s medical record.
You are not required to include the screening score results or a copy of the screening instrument in the child’s record. You 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 maternal depression screening, referral and documentation, refer to Postpartum Depression - Information for Health Professionals and the Maternal Depression Screening FACT Sheet.
Refer to the DHS Children's mental health screening web page for information on the relationship between maternal depression and children’s developmental, social-emotional and mental health.
Bill for the maternal depression screening only when using one of the standardized screening instruments. When billing for a maternal depression screening, refer to the following criteria:
Add a modifier to 96161 on the original claim when using both the code 96161 and any of the immunization administration codes (90460, 90461, 90471-90474). Also add a modifier to 96161 if you have any denied claims for this code pair.
See Minnesota NCCI FAQs page for information on which modifiers to use.
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. The Minnesota Department of Health (MDH) Childhood and Adult Recommended Immunization Schedules, which are revised annually, may be used because they incorporate the ACIP schedule.
State law requires all MHCP enrolled providers who administer pediatric vaccines to enroll in the MnVFC program. MDH administers the Minnesota Vaccines for Children Program (MnVFC) for MHCP recipients ages 1 through 18 to provide most pediatric vaccines to participating providers at no cost. Providers must obtain vaccines through MnVFC whenever available.
MHCP covers flu vaccines and other recommended vaccinations for adults aged 19 or older.
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 the MHCP Provider Manual – Immunizations and Vaccinations section for details on coding and billing criteria.
Immunization and Vaccinations Resources
Refer to the following documents and websites for more information:
Health education is a required component of screening services and includes anticipatory guidance. At the outset, the physical and dental screening gives you the initial context for providing health education. Health education and counseling to both parents (or guardians) and children is required and is designed to assist in understanding what to expect in terms of the child’s development and to provide information about the benefits of healthy lifestyles and practices as well as accident and disease prevention.
Reimbursement for health education and anticipatory guidance is included in the payment of the 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, 0–5 years, 6–12 years, and 13–21 years.
Preventive counseling is included in the preventive medicine E&M service; do not report preventive counseling separately. Report CPT codes 99401–99404 if patient visit is for counseling only.
FVA may be performed at all locations where C&TC services are rendered. Staff must successfully complete an approved FVA training FVA training course. The following types of trained staff may perform FVA:
Apply fluoride varnish in the primary care setting every three to six months starting at tooth emergence and not later than 12 months of age, as recommended by the American Academy of Pediatrics and the US Preventive Task Force.
In 2014, the U.S. Preventive Services Task Force (USPSTF) published the recommendation that "primary care clinicians apply fluoride varnish to the primary teeth of all infants and children starting at the age of primary tooth eruption." In a clinical report published in the September 2014 Pediatrics journal, the American Academy of Pediatrics (AAP) stated, “fluoride is effective for cavity prevention in children.” The AAP also issued new recommendations related to fluoride, including one stating, “fluoride varnish is recommended in the primary care setting every 3-6 months starting at tooth emergence.”
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.
FVA is an MHCP covered service for up to four times per year in the primary care setting for children from birth to the age of 21 years.
FVA billing by primary providers
Use CPT code 99188: Primary care providers (physicians or other qualified health care professionals) and trained clinical staff. This code replaces HCPS Code D1206. You may bill FVA at three- to six-month intervals.
Head Start, WIC, and Public Health Agencies Billing for FVA
Use the following codes:
Primary care providers bill FVA on the same claim as the other C&TC services. MHCP reimbursement rate is per procedure (not per tooth).
When providing FVA at other pediatric visits, bill FVA on the same claim as the other pediatric services.
FVA in the primary care setting and in the community setting under the direct supervision of a treating physician or other qualified health care professional must use CPT code 99188 beginning July 1, 2017. CDT code D1206 will no longer be allowed in these settings after July 1, 2017.
Refer to the Non-Dental Health Provider section under Dental Services for specific billing instructions or for more information.
Dental providers must use CDT code D1206 and may bill MHCP once every six months.
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 in the Minnesota Department of Health (MDH) C&TC web pages, National Maternal and Child Oral Health Resource Center, and the DHS C&TC Provider Guide (DHS-4212) (PDF).
When using both the code 99173 and one of the preventive visit CPT codes in the range of 99381–99397, you need to add a modifier to 99173 on the original claim. You also need to add a modifier to 99173 if you have any denied claims for this code pair.
See Minnesota NCCI FAQs page for information on which modifiers to use.
MHCP recognizes that for some situations it is not possible or appropriate to require C&TC providers to complete certain components of the C&TC screening as outlined in the Schedule of Age-Related Screening Standards. According to the Administrative Uniformity Committee (AUC) recommendations, use the following billing guidelines for the situations listed in the table below when you cannot perform screening component(s) or an initial screening is not appropriate.
Claims submitted using the following guidelines for an exception identified in the table below will be recognized as completed C&TC claims. When submitting a claim, follow these requirements:
Claim guideline exceptions
Claim Reporting and Medical Documentation
Condition already identified (screening is not medically necessary)
Screening recently provided elsewhere
Unsuccessful attempt (Child uncooperative)
Unsuccessful attempt (Child uncooperative)
Screening instrument not reviewed
A developmental screening instrument was sent to parents but not returned for review at the time of the C&TC screening.
The following services are also covered:
If a significant, separately identifiable E&M service is provided at the time of the C&TC screening, that E&M code must be billed with the modifier 25. Documentation in the health record must support key components of billed E&M services. Follow CPT instructions for appropriate coding.
MHCP does not cover the following services under C&TC:
C&TC screening services and screening components do not require authorization. For diagnosis and treatment services that may require authorization, refer to the MHCP Provider Manual - Authorization Section. For clinic or physician services provided to a child not included in the C&TC screening benefit, refer to the MHCP Provider Manual – Physician Services section.
Use the 837P claim to bill for C&TC services. Refer to the MN–ITS User Guide for Child and Teen Checkups when submitting claims via MN–ITS Interactive. If billing X12 Batch, follow HIPAA electronic data interchange (EDI) as outlined in the X12 implementation guides and follow the standards as outlined in the Minnesota Uniform Companion Guides.
C&TC billing processes include complying with HIPAA, AUC and MHCP system and data requirements. Billing C&TC screening services accurately is necessary to do the following:
Follow the Schedule of Age-Related Screening Standards (C&TC Screening Component Periodicity Schedule) (DHS-3379) (PDF) to identify required C&TC screening components for the periodic visit, including a referral to a dentist. Enter the appropriate CPT or HCPCS codes for each age-related component provided in MN–ITS-837P claim form. On claims for C&TC screening services, include the following:
Refer to the Schedule of Age-Related Dental Standards (C&TC Dental Periodicity Schedule) (DHS-5544) (PDF) for dental screening components.
For policy and billing dental screening components, refer to the Dental Services section of this manual.
A referral for C&TC reporting purposes indicates that the child needs to be seen again for further assessment; diagnosis or treatment of a problem; or a concern that was identified during the C&TC screening. The referral can be made to the screening provider or to another provider.
C&TC HIPAA compliant referral condition codes (also called referral codes) indicate if a referral was made as a result of the C&TC screening. C&TC claims must list the most appropriate HIPAA compliant referral condition code: NU, ST, S2 or AV. MHCP C&TC screening payment requires one of the four HIPAA compliant referral condition codes to be entered at the claim (header) level.
Use the most appropriate referral code from the table below:
HIPAA Compliant Referral Condition Code
Use this referral condition code for billing when a C&TC screening results in one of the following:
- or –
AV – refused referral
One or more referrals were made and the patient refused one or more of the referrals (“AV”)
The patient is currently under treatment for a diagnostic or corrective health problem(s)
MHCP does not require the use of HCPCS code S0302 and considers this code as informational only. If a submitted charge is entered on the same line as the HCPCS Code S0302, MHCP will deduct that amount from the total charges on the claim.
If the HCPCS code S0302 is reported without a HIPAA compliant referral condition code on that claim, the claim will deny.
DHS will recognize a claim as a C&TC screening only when a HIPAA compliant referral condition code is entered on the claim.
For policy and billing for lab services, refer to Laboratory/Pathology Services section of this manual.
Department of Human Services (DHS) C&TC resources
Use the MHCP Provider Manual in conjunction with the following DHS resources:
Minnesota Department of Health (MDH) C&TC resources
Other C&TC resources
Training and E-Learning Modules
Fluoride Varnish Online Trainings
Minnesota Statutes 256B.04 (Subd. 1b)
Minnesota Statutes 256B.0625 (Subd. 14) – preventative and screening services
Minnesota Statutes 256B.0625, subd.39 (immunizations)
Minnesota Rules 9505.0275, 9505.1693 to 9505.1748 (C&TC)
42 CFR 440.40(b); 42 CFR 441.50-441.62 (C&TC)
The terminology used to describe people with developmental disabilities has changed over time. While DHS supports the use of “people first” language within its documents, certain outdated terms may still be found within historical and official documents, such as statutes and reports, and other documents created by third parties.
Title XIX, Sections 1902(a)(43), 1905(a)(4)(B), 1905(r) of the Social Security Act (C&TC)