Provider Alert! Additional development screenings and autism screenings now allowable and payable beyond the standard screeningsTexas Children's Health Plan
Effective Date: June 3, 2020
Attention: Primary Care Providers
Call to action: In addition to the required screenings, TCHP is allowing for a total of 12 developmental screenings up to age 6 during a Texas Health Steps Checkup within the following ages:
|8.1- 2 screenings||At ages 0-11 months|
|8.2- 3 screenings||At age 12-23 months|
|8.3- 2 screenings||At ages 12-23 months|
|8.4- 2 screenings||At ages 24-35 months|
|8.5- 1 screening||At 3 years of age|
|8.6- 1 screening||At 5 years of age|
|8.7-1 screening||At 6 years of age|
If a developmental or autism screening that is required in the Required Screening Ages and Recommended Tools table is not completed during a previous checkup or if the member is being seen for the first time, standardized developmental screening tool (ASQ or PEDS) must be completed through 6 years of age (procedure code 96110/96110 U6-for autism screening). As a reminder, Texas Health Steps requires the following standardized developmental screening tools at these ages:
|Required Screening Ages and Recommended Tools|
|Screening Ages||Developmental Screening Tools||Autism Screening Tools|
|9 months||Ages and Stages Questionnaire (ASQ) or Parents’ Evaluation of Development Status (PEDS)||N/A|
|18 months||ASQ or PEDS||Modified Checklist for Autism in Toddlers (M-CHAT) or M-CHAT Revised with Follow-Up (M-CHAT R/F)|
|24 months||ASQ or PEDS||M-CHAT or M-CHAT R/F|
|3 years||ASQ, Ages and Stages Questionnaire: Social-Emotional (ASQ:SE) or PEDS||N/A|
|4 years||ASQ, ASQ:SE or PEDS||N/A|
How this impacts providers: Providers should review and understand the complete Developmental screening guidelines available here: (update link when new guideline document is approved).
- Developmental screening is limited to once per rolling calendar year by any provider, outside of a Texas Health Steps medical checkup when medically necessary.
- This screening should only be competed for a diagnosis of suspected developmental delay or to evaluate a change in developmental status outside of a Texas health Steps medical group.
- If a provider administers a standardized and validated developmental screening at additional checkups other than those listed in the Required Screening Ages and Recommended Tools table, the rationale for the additional screening, which may be due to provider or parental concerns should be documented.
- Autism screening is required at 18 months of age and again at 24 months of age.
- If not completed at 24 months of age it should be completed at 30 months of age.
- A third screening may be performed as a follow-up to a previous abnormal screening by 30 months of age.
- A TCHP Medical Director / Physician Reviewer will review requests for developmental screening outside of these limits on an individual basis.
Texas Health Steps Medical Checkup Periodicity Schedule for Infants, Children, and Adolescents: Click Here.
Next steps for providers: Providers should ensure their understanding of the guidelines and coordinate with their staff.
If you have any questions, please email Provider Network Management at: firstname.lastname@example.org.For access to all provider alerts,log into: www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers