Provider Alert! Billing Update for Texas Health Steps

To: All Texas Health Steps Providers

Subject: Reminder – Billing for Texas Health Steps Services to Texas Children’s Health Plan

Texas Children’s Health Plan follows the State of Texas Medicaid guidelines for Texas Health Steps checkups including the following:

“Texas Health Steps medical checkups reflect the federal and state requirements for a preventive checkup. Preventive care medical checkups are a benefit of the Texas Health Steps program if they are provided by enrolled Texas Health Steps providers and all of the required components are completed. An incomplete preventive medical checkup is not a benefit. The Texas Health Steps periodicity schedule specifies screening procedures required at each stage of the client’s life to ensure that health screenings occur at age-appropriate points in a client’s life.”

As noted in the Periodic Checkup Age Range table, the number of checkups is set for each age range. Members age 5 through 20 are allowed one complete Texas Health Steps visit per calendar year unless there are documented extenuating circumstances as outlined in the Texas Medicaid Provider Procedures Manual Exception-to-Periodicity Checkups.

Providers submitting claims for exception-to-periodicity checkups without the appropriate exception modifier will be denied upon claim submission.

Information on exceptions to periodicity can be found in section 5.3.7 Exceptions to Periodicity Checkups in the Texas Medicaid Provider Procedures Manual Children’s Services Handbook.

For additional information on correct billing of Texas Health Steps, please contact your Provider Relations Manager at 832-828-1008 or toll free 800-731-8527.