Accessing EPSDT Services

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Early and Periodic Screening, Diagnostic and Treatment (EPSDT) is a Health First Colorado program (Colorado’s Medicaid Program) that covers prevention, diagnostic and treatment services for members age 20 and under. This program is set up to find health problems early. The program goal is for children to get the physical, mental, vision, hearing and dental care they need for their health. 

Your child can get these services at no cost to you.
Services include:

Members may self-refer for the following EPDST services:

  • Well Child Check-Ups
  • Immunizations
  • Vision Screening/Eyeglasses
  • Hearing Screening

EPSDT services that require a PCP referral and/or prior authorization (PAR):

  • Speech (PCP Referral)
  • Physical Therapy/Occupational Therapy (PCP Referral)
  • Home Health (PCP Referral and PAR)
  • Substance Use Disorders Treatment (PCP Referral and PAR)

The American Academy of Pediatrics Bright Future Schedule is a list of needed care and how often your child needs care.  For more information visit https://www.colorado.gov/hcpf/early-and-periodic-screening-diagnostic-and-treatment-epsdt

Age Check-up Frequency
0 to 15
months
  • Well child/physical - 8 visits
  • Dental - Every 6 months by age 1 or when first tooth breaks
  • Hearing - 1 check-up in hospital (at birth); 2 check-ups
  • Vision - 1 check-up

 

Age Check-up Frequency
18 months
to 2 years
  • Well child/physical - 3 visits
  • Dental - Every 6 months
  • Hearing - 1 check-up after each middle ear effusion
  • Vision - 1 check-up at 2 years of age
3 to 20
years
  • Well child/physical - 1 visit per year
  • Dental - Every 6 months
  • Hearing - 1 check-up at ages 4-6, 8 and 10
  • Vision - 1 check-up per year from ages 3-8; 1 check-up every 2 years until age 20

In addition, children that have not had Lead Testing need to get one at 12 and 24 months or between the ages of 36 and 72 months.

You can get these services through your PCP within 30 days of calling for an appointment. Your PCP may refer you to other special services available at Denver Health.  EPSDT screening services do not need approval from Denver Health Medicaid Choice (DHMC). Diagnostic services as provided when screening suggests more evaluation or treatment is needed. Most medically necessary (least costly, effective, acceptable medical practice) services needed to treat, correct or prevent illness and condition found by screening or diagnostic tests are covered, and DHMC will not put limits (such as the number of visits allowed) on EPSDT services. Maintenance services may also be covered when needed.
 

Special Considerations or Limitations


There are some services not covered for EPSDT members. For a full listing please consult your DHMC Medicaid Choice handbook. 

Some EPSDT services are not covered by DHMC but are still a benefit to you through Health First Colorado. This kind of care is called a “wrap around” benefit. Please see the Wrap-Around Benefit section of the DHMC Medicaid Choice handbook for more information. 

Most EPSDT services will be available within Denver Health. Your doctor may also refer you to services outside Denver Health.  If you have questions about EPSDT services, you or your doctor may call DHMC Member Services (303)602-2116.  You can also call Healthy Communities. Healthy Communities is a free community resource to help you with finding EPSDT services outside of Denver Health. For more information please visit www.colorado.gov/pacific/hcpf/healthy-communities or call your coordinator. Tri-County (Adams, Arapahoe) 303-874-4404, Denver County 303-602-6770, Jefferson County 303-232-6301.