Policy Changes

June 1, 2021 – Effective for dates of service on or after June 1, 2021, new screening tools — one for developmental screenings for children and another for mental health screenings for adolescents — have been added for Texas Health Steps (THSteps) preventive care medical checkups.

The Survey of Well-being of Young Children (SWYC) has been added as a recognized developmental screening tool for children ages 9 months, 18 months, 24 months, 3 and 4 years, and through 6 years if not completed previously.

The Rapid Assessment for Adolescent Preventive Services (RAAPS) has been added as a recognized mental health screening tool for adolescents ages 12–18.

Providers may refer to the current “Texas Medicaid Provider Procedures Manual, Children’s Services Handbook,” subsection, “Developmental Surveillance or Screening,” and subsection, “Mental Health Screening,” for additional information.

Sept. 1, 2022 – During a declaration of a state of disaster, HHSC may issue direction to providers regarding the use of telemedicine and telehealth services to include the use of a synchronous telephone (audio-only) platform to provide covered services outside the allowances described herein to the extent permitted by Texas law. A declaration of a state of disaster occurs when an executive order or proclamation is issued by the governor declaring a state of disaster in accordance with Section 418.014 of the Texas Government Code.

THSteps checkups billed as synchronous audiovisual or synchronous telephone (audio-only) checkups (procedure codes 99381, 99382, 99391 or 99392) will be denied for clients ages 24 months or younger.

THSteps checkups and exception-to-periodicity checkups delivered through synchronous audiovisual technology must be billed with Modifier 95.

THSteps checkups and exception-to-periodicity checkups delivered through synchronous telephone (audio-only) technology must be billed using Modifier 93.

Checkups billed as exception-to-periodicity checkups must also include the appropriate exception-to-periodicity checkup modifier (Modifier 23, 32, or SC).

Records are subject to retrospective review, and incomplete checkups are subject to recoupment.

For more information, call the TMHP Contact Center at 800-925-9126.