Reimbursement code for sports and camp physicals

Reimbursement code for sports and camp physicals

Effective January 1, 2017, Texas Children’s Health Plan began reimbursing code 97169 – Athletic Training Evaluation, low complexity, as a value added service to CHIP and STAR Members under 21. This code is only reimbursed for sports and camp physicals when a member has also had a THSteps or well child visit within the previous 12 months. Code 97169 will be the only code that is accepted for reimbursement; use of any other Athletic Training Evaluation code (such as 97170-97172) will be denied. This replaces previous code 97005, which was discontinued 12/31/16.

Texas Children’s Health Plan will continue to pay $29.40, which is a flat rate of $30 less than the 2% reduction that was previously paid for 97005. No other modifier will be required for this service.

If you need further clarification, please contact your Provider Relations Manager or call Provider Relations at 1-800-731-8527.

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