CMS-416 Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Health Assessment Form
The CMS-416 form, also known as the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Health Assessment Form, is used to document the results of a comprehensive health assessment for children under the age of 21 who are enrolled in the Medicaid program. The form is used to ensure that children receive the preventive and diagnostic health care services they need to maintain their health and development.
The CMS-416 form consists of several parts, including:
- Identification Information
- Health History
- Physical Examination
- Developmental and Behavioral Assessment
- Laboratory and Diagnostic Tests
- Immunizations
- Health Education and Counseling
- Referral and Follow-Up
The most important fields on the CMS-416 form include the child's name, date of birth, Medicaid identification number, and information about their medical history, physical examination, developmental and behavioral assessment, and immunization status.
The CMS-416 form is compiled by healthcare providers who perform comprehensive health assessments for children enrolled in the Medicaid program. The parties to the document are the healthcare provider and the state Medicaid agency.
When compiling the CMS-416 form, it's important to follow the guidelines and instructions provided by the state Medicaid agency to ensure that all required information is included. This includes documenting the results of all required screenings and assessments and providing appropriate referrals and follow-up care as needed.
One advantage of the CMS-416 form is that it provides a standardized format for documenting the results of comprehensive health assessments for children enrolled in the Medicaid program. This helps to ensure that all necessary screenings and assessments are performed and that children receive the preventive and diagnostic health care services they need.
Problems can arise when filling out the CMS-416 form if the information provided is incomplete or inaccurate. This can result in delays or denials of payment for the services provided.
Related forms to the CMS-416 include the CMS-1500 form, which is used to bill for medical services provided to Medicaid beneficiaries, and the CMS-855I form, which is used by individual healthcare providers to enroll in the Medicaid program.
An alternative form to the CMS-416 is the Bright Futures Periodicity Schedule, which provides guidance on the recommended schedule for preventive health services for children from birth through age 21.
The CMS-416 form is submitted to the state Medicaid agency according to their specific guidelines and requirements. The completed form is stored in the child's Medicaid record.