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43.1.7.3 Newborn Examination
Inpatient newborn examinations billed with procedure codes 1-99431 and 1-99432 are counted as THSteps medical check ups and must include all the necessary components.
The required components of the initial THSteps newborn check up must meet THSteps requirements and must include the following documentation:
• History and physical examination.
•Length, height, weight, and head circumference.
•Sensory screening (vision and hearing appropriate to age).
•Hepatitis B immunization.
•Mandated initial newborn screen at 24-48 hours of age.
•Health education and anticipatory guidance with the parents or a responsible adult who is familiar with the client's medical history. Health education by the nursing staff, individually or in a class, is acceptable.
Note: In Texas the newborn hearing screening is included in the in-hospital newborn exam.
Providers must include and document the required components when billing procedure codes 1-99431 or 1-99432 to the Texas Medicaid Program.
If the provider chooses to do a brief examination (not including all the above components), the provider may bill procedure code 1-99431 or 1-99432 with modifier 52, which does not count as a THSteps check up.
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 well-child care and immunizations. Physicians and hospital staff are encouraged to inform parents eligible for Medicaid that the next THSteps check up on the periodicity schedule should be scheduled at 1 to 2 weeks of age and that regular check ups should be scheduled during the first year.
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