Diagnostic and Treatment Program Services

Diagnostic and Treatment Program Services A. EPSDT diagnostic and treatment services consists of all medically necessary services needed to correct or ameliorate physical or mental illnesses and conditions discovered by a screening, whether or not such services are covered under the State Plan; and for a Medicaid eligible child or youth under age twenty-one (21) years, if the service is determined by the Division of Medicaid or its representative to be medically necessary. B. A medically necessary service is defined as any service that is reasonably necessary to prevent, diagnose, correct, cure, alleviate or prevent the worsening of conditions that endanger life or cause suffering or pain, or result in illness or infirmity, or threaten to cause or aggravate a handicap or cause physical deformity or malfunction. There must also be no other equally effective, more conservative, or substantially less costly course of treatment available or suitable for the client requesting the service. C. To receive payment for any service that is not specifically included as a covered service under any Medicaid Administrative Rule or under the federally approved State Plan, the requestor must submit a request for prior authorization.