Measures Not Included in PCDH Framework

Not applicable

Diagnostic services

Enter the unduplicated number of individuals under the age of 21 with at least 90 continuous days of enrollment during the federal fiscal year who received at least one diagnostic dental service by or under the supervision of a dentist, as defined by HCPCS codes D0100-D0999 (or equivalent CDT codes D0100 –D0999 or equivalent CPT codes, that is, only those CPT codes that are for diagnostic dental services, and only if provided by or under the supervision of a dentist, based on an unduplicated paid, unpaid, or denied claim Numerator: Unduplicated number of individuals under the age of 21 with at least 90 continuous days of enrollment during the federal fiscal yearwho received at least one diagnostic dental service by or under the supervision of a dentist, as defined by HCPCS codes D0100-D0999 (or equivalent CDT codes D0100 –D0999 or equivalent CPT codes, that is, only those CPT codes that are for diagnostic dental services, and only if provided by or under the supervision of a dentist, based on an unduplicated paid, unpaid, or denied claim Denominator: Total unduplicated number of individuals under the age of 21 who have been continuously enrolled in Medicaid or a CHIP Medicaid expansion program for at least 90 continuous days in the federal fiscal year and determined to be eligible for EPSDT services, distributed by age and by basis of eligibility

Measure

Children

Program/Plan

Administrative enrollment and claims data

CMS 416 Measures; DQA Starter Set Measures Environmental Scan (2012); NQF Environmental Scan (2012)

Centers for Medicare & Medicaid Services (CMS)

CMS EPSDT Reporting