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Health
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Effective for dates of service on or
after Dec. 1, 2011, the benefit criteria
for Texas Health Steps preventive
medical checkups will change for Texas
Medicaid.
In accordance with the National Cor-
rective Coding Initiative (NCCI) guide-
lines, procedure code 99211 will not be
separately reimbursed when billed with
a vaccine administration code.
If a Texas Health Steps checkup was
conducted but the member was sick or
the Provider did not have any vaccines
available at that time and had to sched-
ule a follow-up, the Provider can bill for
the vaccines alone.
TEXAS HEALTH STEPS
PERIODICITY SCHEDULE
Hemoglobin type
is now included in
the newborn screening rather than
listed separately on the periodicity
schedule. The newborn screening should
be obtained at up to 12 months of age
if it was not previously obtained; if the
results are not available; or, in special
circumstances such as adoption, if there
is no record of previous test results.
For Texas Health Steps preventive medical checkups
Make sure your information is up-to-date
Benefit changes
Updating provider information
Tuberculosis (TB) screening
: The
TB risk screening tool must be admin-
istered annually to all clients who are
12 months of age and older. The TB
risk screening tool is available in the
forms section of the DSHS website at
www.dshs.state.tx.us/thsteps/forms.shtm
.
Providers must administer a TB skin
test if the screening tool indicates a risk
for possible exposure, rather than at
the specific ages previously required in
certain counties.
Providers must obtain their own sup-
ply of purified protein derivative (PPD).
The state Infectious Disease Control
Unit will no longer provide PPD to
Providers. A TB skin test (procedure
code 86580) may be submitted for
reimbursement when it is performed
as part of a Texas Health Steps medical
checkup. TB screenings are part of the
encounter rates for federally qualified
health centers and rural health clinics
and are not reimbursed separately.
Lead Poisoning
: Blood lead test-
ing must be performed during the
12- and 24-month checkups, as in-
dicated on the periodicity schedule.
Blood lead testing (procedure code
83655) may be reimbursed to Texas
Health Steps medical Providers when
it is performed in the Provider’s of-
fice using point-of-care testing. The
confirmatory specimen may be sent to
the DSHS lab, or the client or specimen
may be sent to a lab of the Provider’s
choice. Providers who perform point-
of-care lead testing must be Clinical
Laboratory Improvement Amendments
(CLIA)-certified. Procedure code 83655
is a CLIA-waived test and must be sub-
mitted with modifier QW.
The newly revised Texas Health Steps
periodicity schedule is available on
our website in our Texas Health Steps
Resource page at
www.epfirst.com/
ProvidersEPSTD.html.
It is essential for Texas Medicaid
Providers to have the most current
Provider demographic information for
both billing processes and member
accessibility. Providers should notify
the Texas Medicaid
& Healthcare
Partnership
(TMHP) of any
necessary updates
as well as contact
their contracted
managed care
organizations.
Providers can now update their
information online through the TMHP
website. Simply log in with your
TexMedConnect user name and click
on “My Profile” to make any changes or
verifications. Any updated information
will appear immediately after saving.
Providers without
Internet access can
manually update their
information using the
provider information
change form.