Provider updates

As of January 1, 2023, CareOregon covers EPSDT services below the funding line on the Prioritized List of Health Services when medically necessary and medically appropriate. The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit provides comprehensive and preventive health care services for Medicaid children under the age of 21. Services will be reviewed regardless of line placement, pairing and quantity limits.

Prior authorizations should continue to be submitted per CareOregon’s established authorization request process.

Please note that not all requests for members below the age of 21 will fit the definition of EPSDT services. Medical necessity and medical appropriateness are determined on a case-by-case basis.

Additional information may be found at: www.oregon.gov/EPSDT, including:

• EPSDT Policy Change Memo for OHP providers  
• EPSDT Guidance for OHP Providers   
• EPSDT Fact Sheet for OHP members