Reporting 24H EPSDT/Family Plan
Enter the response in the shaded portion of the field as follows. If there is no requirement (for example, state requirement) to report a reason code for EPDST, enter “Y” for yes, or “N” for no.
If there is a requirement to report a reason code for EPDST, enter the appropriate reason code as noted below.
• 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.)
Family Planning:
If the service is for family planning, enter “Y” for yes, or “N” for no in the bottom unshaded area of the field.
Enter the response in the shaded portion of the field as follows. If there is no requirement (for example, state requirement) to report a reason code for EPDST, enter “Y” for yes, or “N” for no.
If there is a requirement to report a reason code for EPDST, enter the appropriate reason code as noted below.
• 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.)
Family Planning:
If the service is for family planning, enter “Y” for yes, or “N” for no in the bottom unshaded area of the field.