Clinical Guidelines

To help provide our members with consistent, high-quality care that utilizes services and resources effectively, we have chosen certain clinical guidelines to help our providers. These are treatment protocols for specific conditions as well as preventive health guidelines.

These guidelines are intended to clarify standards and expectations. They should not:

  • Come before your responsibility to provide treatment based on the member’s individual needs.
  • Substitute as orders for treatment of a member.
  • Guarantee coverage or payment for the type or level of care proposed or provided.

We have adopted these evidence-based guidelines.

To learn more about the guidelines and to access helpful tool kits on treating various behavioral disorders, follow the links below:

If you are a pediatrician or family medicine practitioner working with children, make sure you fully understand the Early Periodic Screening, Diagnosis and Treatment (EPSDT) Program and are familiar with the Childhood Immunization Schedule.

  • EPSDT Program: To help ensure children under age 18 get the screenings and preventive care they need, please refer to the EPSDT Periodicity Schedule.

Childhood Immunization Schedule

Well Visit Codes for EPSDT Members

 

Well-Visit Ages New Patients

CPT Codes

ICD-10 Codes

 

Well-Visit Ages Established Patients

CPT Codes

ICD-10 Codes

Infant (Younger than 1 Year)

99381

Z00.110 Z00.111 Z00.121 Z00129

 

Infant (Younger than 1 Year)

99391

Z00.110 Z00.111 Z00.121 Z00.129

1-4 Years

99382

Z00.121 Z00.129

 

1-4 Years

99392

Z00.121 Z00.129

5-11 Years

99383

Z00.121 Z00.129

 

5-11 Years

99393

Z00.121 Z00.129

12-17 Years

99384

Z00.121 Z00.129

 

12-17 Years

99394

Z00.121 Z00.129

18 Years or Older

99385

Z00.00 Z00.01

 

18 Years or Older

99395

Z00.00 Z00.01

 For additional Clinical Practice Guidelines and comprehensive list of Preventative Screening tests please look here.  

If you are treating children with behavioral health disorders, Mercy Care offers a variety of resources related to anxiety, depression, ADHD, and children with special needs.