Reimbursement Policy:

Reimbursement of S0302

Effective Date:

October 24, 2022

Purpose:

To provide billing and reimbursement guidelines for add on procedure code S0302.

Scope:

Definitions:

S0302: Completed early periodic screening diagnosis and treatment (EPSDT) service (list in addition to code for appropriate evaluation and management (E&M) service)

Policy:

Early periodic screening diagnosis and treatment (EPSDT) is a service provided to children from birth through 21 years of age who are eligible for Medicaid. The EPSDT add-on code S0302 should only be reported when all components of an EPSDT visit have been performed with preventative medicine services CPT codes 99381-99385 or 99391-99395. S0302 should be reported on a separate line from the previously mentioned E&M codes.

S0302 is not eligible for reimbursement. It is required to be submitted on a claim for reporting and informational purposes only, when the above conditions have been met. Providers should continue to submit this code regardless of reimbursement status.

Procedure:

Horizon NJ Health will not consider for reimbursement procedure code S0302 when billed during the same session as CPT codes 99381-99385 or 99391-99395.

References:

American Medical Association, Current Procedural Terminology (CPT®) Professional Edition and associated publications and services

Limitations and Exclusions:

Notwithstanding the foregoing, all payment determinations are subject to all other, applicable limitations, including but not limited to, the following:

• Benefit Limitations;
• The terms of any applicable provider participation agreement;
• Routine claim editing logic, including but not limited to incidental or mutually exclusive logic;
• Medical necessity; and
• Applicable law, regulatory guidance, government mandates, and the terms of the Managed Care Contract between Horizon NJ Health and the New Jersey Department of Human Services, Division of Medical Assistance and Health Services.

History:

8/25/2022: Policy approved.

Policy014M