6.3.1.8 Newborn ExaminationProviders do not have to be enrolled as THSteps providers to bill newborn examination procedure codes 99460, 99461, 99462, and 99463. Newborn examinations that are billed with procedure code 99460 or 99461 may be counted as a THSteps medical checkup when all required components are completed and documented in the medical record. If a brief newborn examination is performed that does not fulfill THSteps medical checkup criteria, providers may bill procedure code 99460 or 99461 with modifier 52, which does not count as a THSteps visit. Providers must use their Medicaid provider identifier when billing newborn examination services. To qualify as a THSteps checkup, the initial newborn examination must meet the THSteps periodicity requirements and must include the appropriate required documentation. Note: In Texas, the mandated newborn hearing screening and newborn screening test is included as part of the in-hospital newborn exam. Providers billing these newborn codes are not required to be THSteps providers, but they must be enrolled as Medicaid providers. TMHP encourages THSteps enrollment for all providers that offer a medical home for clients and provide them with medical checkups and immunizations. Physicians and hospital staff are encouraged to inform parents eligible for Medicaid that the next THSteps checkup on the periodicity schedule should be scheduled at 3 to 5 days of age and that regular checkups should be scheduled during the first year. Refer to: Subsection 6.3.38, "Newborn Services" in Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook (Vol. 2, Provider Handbooks) for additional information on inpatient newborn services. THSteps online education module "Newborn Hearing Screening" on the THSteps website at www.txhealthsteps.com for additional information about conducting a newborn hearing screen. |
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Texas Medicaid & Healthcare Partnership CPT only copyright 2009 American Medical Association. All rights reserved. |
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