Provider Alert! Date: Temporary Flexibilities for Nutritional Counseling and Texas Health Steps (THSteps) Checkups Will End When Public Health Emergency EndsTexas Children's Health Plan
Date: May 5, 2022
Attention: All Providers
Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated with the COVID-19 event. TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event.
Call to action: The purpose of this communication is to inform providers of the upcoming changes for the temporary flexibilities that have been allowed during the public health emergency (PHE) regarding nutritional counseling and Texas Health Steps (THSteps) checkups. The flexibilities permitting telemedicine (audio-visual) and telephone (audio-only) will end when the federal public health emergency (PHE) ends.
How this impacts providers:
When Health and Human Services (HHSC) receives notice from federal authorities that the PHE is ending, a notice will be issued to announce the end date. Temporary flexibilities that will end at this time include the following:
For nutritional counseling, HHSC authorized providers to bill procedure code S9470 for telephone (audio-only) nutritional counseling delivered from March 15, 2020, through the end of the PHE. Providers should continue to use modifier 95 to indicate that remote delivery has occurred.
To help ensure the continuity of care during the COVID-19 response, HHSC authorized THSteps checkups for children 24 months and older through telemedicine (audio-visual) and telephone (audio-only) delivery during the COVID-19 PHE. This direction will remain in effect until the end of the PHE.
As a reminder, telemedicine (audio-visual) and telephone (audio-only) checkup services are not permitted for children birth through 24 months of age (i.e. from newborn checkup through the “24 month” checkup). Telemedicine (audio-visual) delivery is preferred over telephone (audio-only) delivery.
The following procedure codes, when billed with modifier 95, are allowed for THSteps checkups through the end of the PHE for children over 24 months of age:
|Description of Services||Procedure Codes|
|New Patient – THSteps Preventive Medical Checkup||99382, 99383, 99384, 99385,|
|Established Patient – THSteps Preventive Medical Checkup||99392, 99393, 99394, 99395|
All THSteps checkups completed as a telemedicine (audio-visual) or telephone (audio-only) checkup require an in-person THSteps follow-up visit (procedure code 99211) within six months of the checkup date. Outstanding checkup components (i.e. immunizations and physical exams) which could not be completed during the telemedicine (audio-visual) or telephone (audio-only) checkup must be completed at the in-person follow-up visit within six months of the telemedicine checkup regardless of the end date of the PHE.
Texas Children’s Health Plan (TCHP) will work to ensure providers completing telemedicine or telephone THSteps checkups May 7, 2020, through the end of the federal PHE conduct the required in-person THSteps follow-up visit. For dates of services beginning the first day after the end of the federal PHE and later, THSteps providers will no longer be authorized to submit modifier 95 with the above procedure codes and will no longer be authorized to deliver a THSteps checkup by telemedicine (audio-visual) or telephone (audio-only).
Next steps for providers: Once we learn of the end date of the temporary flexibilities there will be an updated communication from TCHP.
- Providers can refer to the Texas Medicaid Provider Procedures Manual (TMPPM), Telecommunication Services Handbook for additional information about the fee-for-service Texas Medicaid telehealth services benefit. Nutritional counseling by synchronous audio/visual technology will continue to be allowed in fee-for-service as outlined in the TMPPM.
- For additional information about THSteps checkups and follow-up visits, providers can refer to the Texas Medicaid Provider Procedures Manual, Volume 2, Children’s Services Handbook.
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.