Provider Alert! No-cost sports and school physicals for CHIP and Medicaid patients

Date: July 13, 2023

Attention: Primary Care Providers, OB/GYNs, and Office Managers

Call to action:  It will soon be back-to-school season, which means your patients will need to complete their annual sports and school physicals. As part of the Healthy Rewards Program*, Texas Children’s’ Health Plan CHIP, STAR and STAR Kids members ages 5 to 19 years** can receive a no-cost sports and school physical. A Texas Health Steps or well-child visit within the last 12 months is required. Members should bring their camp or school physical form to be completed during the visit.

How this impacts providers: Providers will be reimbursed for the cost of the sports and school physical.

For reimbursement of the sports and school physical, please use code 97169 – Athletic Training Evaluation, low complexity. Use of any other Athletic Training Evaluation code (such as 97170-97172) will be denied.

Next steps for providers: Providers should share this communication with their staff.

*Restrictions and limitations may apply. Age range may vary by plan. Extra benefits valid during the eligible year (September 1, 2022 to August 31, 2023). Must be an active Texas Children’s Health Plan member to receive extra benefit. The member must be an active member at the time of verification. Purchase of alcohol, tobacco, illegal drugs or firearms is prohibited with the reward cards. Unless otherwise stated, rewards are limited to one member per eligible year. Depending on the benefit, reward can be requested up to 60 days after the end of the eligible year. For most of the extra benefits, allow up to 90 days for delivery of reward.

**This healthy reward included members’ ages 5 to20 years previously, which ended August 31, 2022.

If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org.

For access to all provider alerts,log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.