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Billing for CHCUP

Claims submitted for Child Health Check Ups must contain:

  • Box 24 H. (EPSDT) Family Plan (listed next to the days and units box) must have the correct referral code. Please see below.

For electronic claims (837 Professional)

Providers who bill electronically using the 837P format must select the appropriate response for ASC X12N 837: Loop 2300 element CRC02 – "Was an EPSDT referral given to the patient? (Yes or No)" and provide the appropriate condition indicator in element CRC03 of the electronic claims file. Completion of elements CRC02 and CRC03 are required for electronic claims.

For paper claims (CMS1500)

Providers who submit EPSDT paper claims must complete field 24H (EPSDT Family Plan) on the CMS1500 claim form.
Acceptable Referral Codes for CHCUP

  • U Complete Normal
    Indicator is used when there are no referrals made.
  • 2 Abnormal, Treatment Initiated
    Indicator is used when a child is currently under treatment for referred diagnostic or corrective health problem.
  • T Abnormal, Recipient Referred
    Indicator is used for referrals to another provider for diagnostic or corrective treatments or scheduled for another appointment with check-up provider for diagnostic or corrective treatment for at least one health problem identified during an initial or periodic check-up (not including dental referrals).
  • V Patient Refused Referral
    Indicator is used when the patient refused a referral.

This information can also be found in the Provider Manual (PDF) under child health check-up.