Periodicity Schedule

1. (A) Providers of Periodic and Interperiodic Visits.

   1. (1) Primary care providers must offer to conduct periodic and medically necessary interperiodic visits to screen all members younger than 21 years of age (except members enrolled in MassHealth Limited) in accordance with the Medical Schedule, and must provide or refer such members to assessment, diagnosis, and treatment services.
   2. (2) Hospitals and community health centers that provide primary care services must offer to conduct periodic and medically necessary interperiodic visits to screen all members younger than 21 years of age (except members enrolled in MassHealth Limited) in accordance with the Medical Schedule, and must provide or refer such members to assessment, diagnosis, and treatment services.
   3. (3) The health assessments described in the Medical Schedule are payable when provided by a physician, certified nurse practitioner, certified nurse midwife, hospital, community health center, or physician assistant.

Commonwealth of Massachusetts Subchapter Number and Title Page

MassHealth 1. Introduction

1-39

Provider Manual Series (130 CMR 450.000)

Transmittal Letter Date

All Provider Manuals

ALL-224 12/18/17

1. (B) Providers of Dental Services.

   1. (1) Dental care providers must offer to provide services listed in Appendix W: EPSDT Services: Medical and Dental Protocols and Periodicity Schedules of all MassHealth provider manuals to all members younger than 21 years of age (except members enrolled in MassHealth Limited) in accordance with the Dental Schedule, and must provide or refer such members to assessment, diagnosis, and treatment services.
   2. (2) The dental services described in the Dental Schedule are payable when provided by dental providers as described in 130 CMR 420.000: Dental Services.

2. (C) Explanation of Procedures.

   1. (1) The Medical Schedule outlines the procedures for comprehensive preventive care that help to identify members who may require further diagnosis of suspected or actual health problems, treatment of these problems, or both.
   2. (2) The Medical Schedule explains procedures that must be documented in the medical record.
   3. (3) The Dental Schedule is a tool to help dental providers identify members with suspected or actual dental problems that may require additional investigations, diagnosis, or treatment.