Annual Early and Periodic Screening, Diagnostic and Treatment Services (EPSDT) Participation Report

Annual Early and Periodic Screening, Diagnostic and Treatment Services (EPSDT) Participation Report (CMS-416)

OMB: 0938-0354

IC ID: 7986

Documents and Forms

Document Name Document Type
Form CMS-416 Annual Early and Periodic Screening, Diagnostic and Treatment Services (EPSDT) Participation Report Form
CMS-416 Annual EPSDT Participation Report CMS416 final with PRA.xlsx Form
CMS416InstructionsUpdated508.pdf Instruction
CMS-416 Instructions Updated redline 022323.docx Track Change: Instructions IC Document
416InstructionsCrosswalk508-1.pdf Crosswalk: Instructions IC Document