Child and Teen Checkups (C&TC) is the name for Minnesotas 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) 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 encourage the development of good health habits.
The federal Centers for Medicare and 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/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/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 assist in reducing 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 either be enrolled as:
Staff eligible to provide some components under supervision of a physician or dentist includes:
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).
Refer to the Schedule of Age-Related Screening Standards (C&TC Screening Component Periodicity Schedule) (DHS-3379) for Minnesotas age-related screening standards schedule details. Refer to the DHS C&TC Provider Guide (DHS-4212) for more information on screening components.
The C&TC dental screening components include:
Refer to the Schedule of Age-Related Dental Standards (C&TC Dental Periodicity Schedule) (DHS- 5544) for Minnesotas age-related dental standards schedule details.
For details on dental benefit coverage policy, refer to the Dental Services section of this manual.
A blood lead test at ages 12 and 24 months is a federally required component of C&TC. Research indicates that MA/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) 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 16 months and 30 months of age 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.
Lab services must be performed and billed by a CLIA certified lab.
Blood Lead Resources:
All children/adolescents should be evaluated for their risk of exposure to TB. High-risk children include:
TB testing is recommended for high-risk children/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 TB testing is performed 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 mental health surveillance/screenings are a C&TC screening component. To receive additional reimbursement for a developmental and/or mental health screening, providers must use a standardized screening instrument. Without the use of a standardize screening instrument, reimbursement for developmental and/or mental health surveillance/screening is included in the payment of the E&M code used for a C&TC visit.
To use a standardized instrument, providers need to meet the instrument-specific criteria, as outlined by the publisher. Providers that may use the standardized instruments could include physicians, nurse practitioners, physician assistants, nurses, medical assistants or other appropriately trained staff.
Currently, no recommended standardized instrument adequately covers both developmental and mental health screening domains. Two separate screening instruments are needed to adequately screen for potential developmental and mental health concerns.
Required documentation must be maintained in the childs health record and at a minimum includes the name of the screening instrument used, the score and the anticipatory guidance related to the screening results. If the screening results are abnormal, documentation must include how this is being addressed such as referral to Help Me Grow, other appropriate medical specialist(s), follow-up plan of care, and when appropriate, a referral to local community service agency.
Refer to Developmental and Social-Emotional Screening of Young Children (0-6 years of age) in Minnesota for instruments recommended by the Minnesota Interagency Developmental Screening Task Force, including a list of All Instruments at a Glance (PDF). The Task Force no longer recommends the Denver II and thus MHCP will no longer reimburse providers when this tool is used.
Refer to the Mental Health Screening (6-21 years) FACT Sheet (PDF) for a list of instruments recommended by the DHS Childrens Mental Health Division and MDH.
For more information on developmental and social-emotional screening and recommended instruments, refer to the DHS Childrens Mental Health Division Screening website
For more information on recommended mental health and substance abuse, screening tools refer to Bulletin #12-53-01.
Bill the developmental and/or mental health screening on the same claim as other C&TC services. Use:
You may bill for both a developmental and a mental health screening on the same date of service, on the same claim.
When a developmental and mental health screening is provided at other pediatric visits, bill the developmental and mental health screening on the same claim as the other pediatric services.
A standardized screening instrument must be used for autism screening. Without the use of a standardized screening instrument, reimbursement for autism screening is included in the payment of the E&M code used for the C&TC visit.
The immunization status of a child must be reviewed and 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) Recommended Immunization Schedule, for Children and Adolescents, which is revised annually, may be used as it incorporates 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) to provide most pediatric vaccines to participating providers at no cost. Providers must obtain vaccines through MnVFC whenever available.
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:
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 childs 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/Anticipatory Guidance, refer to the Anticipatory Guidance (0-5 years), (6-12 years), and (13-21 years) FACT Sheets
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.
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 below when screening component(s) cannot be performed or an initial screening is not appropriate.
Claims submitted using the following guidelines for an exception identified below will be recognized as completed C&TC claims.
Claim Reporting and Medical Documentation
Contraindication (Service recently performed 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
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.
FVA may be performed at all locations where C&TC services are rendered. Upon successful completion of an approved training course, the following providers may perform the FVA procedure:
Obtain a signed consent form from a parent or legal guardian before providing the FVA. Keep the signed consent form with the childs health records. In addition to a signed consent form, documentation of primary caries preventive services should be in the health record. It is not necessary to get a new parental consent form each time you apply the FVA if there is a signed consent form in the childs record. Refer to the DHS C&TC Provider Guide for more information.
It is recommended that high risk infants and young children receive FVA at 3-6 month intervals, beginning when the first tooth erupts or by 12 months of age. Apply fluoride varnish to a childs teeth as often as every three to six months. Medical providers may bill FVA up to four times per year, per child, as indicated by risk/susceptibility.
Bill the FVA using the CDT code D1206 on the same claim as the other C&TC services. MHCP reimbursement rate is per procedure (not per tooth).
When FVA is provided at other pediatric visits, bill FVA on the same claim as the other pediatric services.
For more information on FVA, refer to the National Maternal and Child Oral Health Resource Center and the DHS C&TC Provider Guide (DHS-4212).
Maternal depression screening is covered as a C&TC service or at other pediatric visits as follows:
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 three maternal depression screenings for a mother per child less than one year of age. For documenting maternal depression screening service, record the name of the completed screening instrument and that the screening was performed as a risk assessment in the childs medical record.
You are not required to include the screening score results or a copy of the screening instrument in the childs 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, refer to the DHS C&TC Provider Guide (DHS-4212).
Bill for the maternal depression screening only when one of the standardized screening instruments is used. When billing for a maternal depression screening:
May be billed on the same date as a childs developmental screening (96110), and or a mental health screening (96110 UC
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 MNITS User Guide for Child and Teen Checkups when submitting claims via MNITS Interactive. If billing X12 Batch, follow HIPAA electronic data interchange (EDI) as outline in the X12 implementation guides and follow the standards as outline 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:
Follow the Schedule of Age-Related Screening Standards (C&TC Screening Component Periodicity Schedule) (DHS-3379) to identify required C&TC screening components for the periodic visit including a referral to a dentist. Enter the appropriate CPT/HCPCS codes for each age-related component provided in MN-ITS-837P claim form. On claims for C&TC screening services, include:
Refer to the Schedule of Age-Related Dental Standards (C&TC Dental Periodicity Schedule) (DHS- 5544) for dental screening components.
For policy and billing dental screening components, refer to the Dental Service 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 which 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:
No referral(s) given (NU)
If only a verbal dental referral was made for preventive dental health care
One or more referrals were made (ST)
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 only recognize a claim, as a C&TC screening 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.
For additional C&TC Information, refer to the DHS C&TC Provider Guide (DHS-4212), designed to offer providers and clinic staff basic information about the C&TC Program, component standards, and documentation requirements. Use the DHS C&TC Provider Guide in conjunction with the MHCP Provider Manual. Additional resources available from the Minnesota Department of Human Services (DHS) include:
C&TC Provider Training and E-Learning Modules
Fluoride Varnish Web-Based Training
Centers for Medicare & Medicaid (CMS) Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program
MS 256B.04 (Subd. 1b)
MS 256B.0625 (Subd. 14) preventative and screening services
MS 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)