Library: Policy

317:30-3-65.10. Periodic and interperiodic screening examinations

Revised 10-1-18

(a) Periodic screening examination. Periodic screenings must be provided in accordance with the recommended American Academy of Pediatrics' Bright Futures' periodicity schedule following the initial screening.

(b) Interperiodic screening examination.Interperiodic screenings must be provided when medically necessary to determine the existence of suspected physical or mental illnesses or conditions. This may include, but is not limited to, physical, mental or dental conditions. The screening components must include health and physical history, physical examination, assessment and administration of necessary immunizations, check of nutritional status, appropriate lab and x-ray and anticipatory guidance. The determination of whether an interperiodic screen is medically necessary may be made by a health, developmental or educational professional who comes into contact with the member outside of the formal health care system. Claims for interperiodic screenings must be billed under the appropriate Current Procedural Terminology codes on form HCFA-1500 for services that are determined medically necessary.