TMPPM 2008 > Texas Medicaid Services > Certified Nurse-Midwife (CNM) > Benefits and Limitations

14.3.2 Newborn Exams

Newborn examinations billed with procedure codes 1-99431 and 1-99432 may be counted as a THSteps periodic medical check up when all necessary components are completed and documented in the medical record. Providers may submit a claim to TMHP using their acute care provider identifier. Providers do not have to be enrolled as THSteps providers to bill these newborn codes.

If a brief newborn examination is performed that does not fulfill periodic check up criteria, the provider may bill 1-99431 with modifier 52 (reduced services) or 1-99432 with modifier 52 using their acute care provider identifier. Providers do not have to be enrolled as THSteps providers to bill these procedure codes.

A THSteps newborn screening exam includes family and neonatal history:

•Physical exam, including length, weight, and head circumference.

•Vision and hearing screening.

•Health education.

•State-required newborn hereditary/metabolic laboratory testing.

•Hepatitis B immunization.

Refer to: Section 43.1.6.2, "Newborn Examination" .

Bill antepartum/postpartum services using the following procedure codes with modifier TH:

Refer to: "Maternity Service Clinic (MSC)" for more information about antepartum care, risk assessment, document requirements, postpartum care, and frequency of services.

"Family Planning Services" on page 20-1 for more information.