Updated: July 17, 2026

CYSHCN Outreach Materials

• Camp Burnt Gin English Brochure (pdf)
  • Obtenga más información sobre el Campamento Burnt Gin (formato PDF)
• CYSHCN Flyer (pdf)
  • Español (formato PDF)
• CYSHCN Brochure (pdf)
  • Español (formato PDF)

Reimbursement Rates, Authorized Equipment & Supplies, and Fee Schedules

• Provider Reimbursement Information (pdf)
• Physician Fee Schedule (pdf)
• Pediatric Subspecialist Fee Schedule (pdf)
• Hearing Services Fee Schedule (pdf)
• Orthodontic Fee Schedule (pdf)
• Dental Fee Schedule (pdf)
• PT & OT Fee Schedule (Appendix 9) (pdf)
• Hospital Reimbursement Rates (Appendix 5) (pdf)
• DME Fee Schedule (Appendix 3) (pdf)

Forms, Manuals, and Policies

• CYSHCN Services Request Form (DPH 4290) (pdf)
• CYSHCN Prescription for the Provision of Formula and Nutritional Supplements (DPH 4006) (pdf)
• Orthodontia Provider Manual (pdf)
• CYSHCN Hearing Aid Battery Request (DPH 4332) (pdf)
  • Solicitud de batería para audífonos (pdf)
• Hearing Authorization Request Form (DPH 4475) (pdf)
• Orthodontic Services Policy (pdf)
• Hearing Services Policy (pdf)
• Special Formula Policy (pdf)

Provider Lists

• Orthotic Prosthetic Provider List (pdf)

Additional Information

• Learn More About DPH's Services for Children and Youth with Special Health Care Needs
• Contact the CYSHCN Program