TMPPM 2008 > Texas Medicaid Services > Texas Health Steps (THSteps) > Clinical Information

43.2.3.8 Tuberculosis Screening

The periodicity schedule for tuberculin tests is in accordance with federal Centers for Disease Control and Prevention (CDC) guidelines. THSteps requires a form of TB screening annually, as noted on the periodicity schedule, that is to be performed in the provider's office or clinic. This screening must be either the TB Questionnaire or a TB Mantoux skin test as described below. The TB Questionnaire was developed by the DSHS Infectious Disease Control Unit TB Program to determine if the clientclient is at high risk for contracting TB and needs Mantoux skin testing. Providers may photocopy the questionnaires from Appendix C of this manual or download the form at www.dshs.state.tx.us/idcu/disease/tb/forms/#clinic. Select EF12-11494 (English) or EF12-11494A (Spanish).

If any question on the questionnaire is answered with a "yes" or "I don't know," a TB Mantoux skin test is to be performed at the visit, unless medically contraindicated (e.g., has a history of a previous positive purified protein derivative [PPD] test). If all questions are answered with a "no," the client does not need to have skin testing unless the provider believes it is needed for other medical reasons. Any newly-identified positive reactions should be evaluated by a screening provider or referred for evaluation. Report any suspected cases or diagnosed cases of TB to the client's local or regional health department.

Providers should contact their local or regional health department to determine whether their service area is a low- or high-prevalence area for TB. A listing of counties with a high prevalence for TB is available at www.dshs.state.tx.us/idcu/disease/tb/statistics/hiprev/default.asp. Providers can also call the TB program at 1-512-458-7447 for more information.

In areas determined to be low-prevalence for TB, the TB Questionnaire should be administered annually beginning at 1 year of age. A TB skin test should be performed if the TB Questionnaire indicates a risk factor or if the provider determines that a TB skin test is appropriate.

In areas of high TB prevalence, the provider shall administer the TB skin test at 1 year of age and once between 4 through 6 years of age then again between 11 through 17 years of age. In those age ranges where a skin test is recommended, the provider should administer the skin test at one of these ages and the questionnaire at the other annual check ups. However, the questionnaire should be administered if the client refuses the skin test or the client is uncooperative.

The TB skin test also should be administered at any time a risk factor is indicated or the provider determines a skin test is appropriate. TB skin tests should be performed on clients who have been in contact with a case of active TB, have lived in a homeless shelter, have been incarcerated or live with someone who has been incarcerated, have lived or visit regularly in an area endemic for TB, currently work in a health-care setting, recently immigrated from a country with a high prevalence of TB, or have associated with someone with human immunodeficiency virus (HIV) infection.

Important: "Live virus vaccines can interfere with response to a tuberculin test (TB). TB testing, if otherwise indicated, can be performed either on the same day that the live virus vaccines are administered or no sooner than 4 to 6 weeks later." Morbidity and Mortality Weekly Report (MMWR), Vol. 43 #RR 1, p. 15.

The materials (PPD-Mantoux antigen and syringe) are available free of charge to the provider at the provider's local or regional health departments. Tine® testing materials should not be used. The cost of administering the test is included in the medical check up fee. A follow-up medical check up visit is required to read all TB skin tests. The provider may bill the follow-up medical check up fee of $14.96 for visit procedure code S-99211 with a THSteps provider identifier. Providers must indicate on the claim procedure code 5-86580 when a skin test is performed. It is not necessary to track the completion of the TB Questionnaire on the claim.

If further evaluation is required to diagnose either latent TB infection or active TB disease, the provider may bill the appropriate office visit code. Diagnosis and treatment are provided as a medical office visit.

THSteps providers may obtain PPD-Mantoux antigen and syringes from their local or regional DSHS office. They will be requested to sign a DSHS Infectious Disease Control Unit PPD Agreement.

Refer to: "Guidelines: Tuberculosis Skin Testing (2 Pages)" for guidance on the evaluation of a positive skin test.

"TB Questionnaire".

"Cuestionario Para la Detección de Tuberculosis".

"PPD Agreement for Texas Health Steps Providers".