KMAP BULLETIN: EP Modifier for EPSDT Medically Necessary Non-Covered Services

Date: 08/08/23

KMAP GENERAL BULLETIN 23192 (PDF)

Effective with dates of service on or after August 1, 2023, the EP modifier will be used to distinguish non-covered state plan services deemed medically necessary for coverage under the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit. 

Medical necessity must be established, and prior authorization must be obtained. Service limitation may be exceeded when authorized for EPSDT. Kansas Medical Necessity is defined in regulation at KAR 30-5-58 (ooo). 

When a code is used with the EP modifier, that service will be allowed for coverage under EPSDT. The Social Security Act covers all medically necessary services that are included within the categories of mandatory and optional services listed in section 1905(a), regardless of whether such services are covered under the State Plan.

Note: The effective date of the policy is August 1, 2023. The implementation of State policy by the KanCare Managed Care Organizations (MCOs) may vary from the date noted in the Kansas Medical Assistance Program (KMAP) bulletins. The KanCare Open Claims Resolution Log on the KMAP Bulletins page documents the MCO system status for policy implementation and any associated reprocessing completion dates once the policy is implemented.