Box 24h - EPSDT/Family Plan

What is it?

Box 24h is used to identify services that may be covered under specific state plans.

If there is a requirement to use a specific reason code, then you would enter that code in the EPDST field on the session instead of entering a Y or N. This code lets the insurance know the referral status and may be specific to each payer.

The following codes for EPSDT can be used:

• AV Available – Not Used (Patient refused referral.) 
• S2 Under Treatment (Patient is currently under treatment for referred diagnostic or corrective health problem.) 
• ST New Service Requested (Referral to another provider for diagnostic or corrective treatment/scheduled for another appointment with screening provider for diagnostic or corrective treatment for at least one health problem identified during an initial or periodic screening service, not including dental referrals.) 
• NU Not Used (Used when no EPSDT patient referral was given.) 

If the service is Family Planning, enter Y (“YES”) or N (“NO”) in the bottom, unshaded area of the field.

In Application:

To manually change this information:

1. Navigate to Billing > Bill Insurance.
2. Use Select Client to choose the desired client.
3. Locate the session and select the corresponding icon.
4. Under Billing & Coding, enter the code into the EPSDT field.
5. Select Save & Done.

EDI File

Loop 2400, Segment SV111