Early Intervention Programs

Early intervention programs for children from birth to age 3 with developmental delays or high risk — including component services (speech, PT, OT, family psychological counseling, nursing, stimulation) and services specified in an Individualized Family Service Plan (IFSP) — are covered, but specific procedure/HCPCS codes (CPT 92521–92524; HCPCS S0302, S9123–S9131, T1000–T1003) and diagnosis codes (ICD‑10 F80.0–F82, R62.0–R62.59, Z13.40–Z13.49) are not covered. Coverage is contingent on the child having an eligible condition or an IFSP and varies by state and plan sponsor, as not all payers/plans provide these benefits.

"HCPCS codes not covered for indications listed in the CPB: S9123 Nursing care, in the home; by registered nurse, per hour (use for general nursing care only, not to be used when CPT codes 99500-996..."

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