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43.1.9 Claims Information
43.1.9.1 Procedure Coding for THSteps Medical Check Ups
The following are procedure codes and reimbursement fees for medical check ups:
Claims for THSteps medical check ups must be submitted with the appropriate procedure codes (S-99381, S-99382, S-99383, S-99384, S-99385, S-99391, S-99392, S-99393, S-99394, and S-99395) and diagnosis code V202. Procedure codes S-99385 and S-99395 are restricted to clients 18 through 20 years of age for a THSteps medical check up.
THSteps medical check ups performed in an FQHC or RHC setting are paid an all-inclusive rate per visit. For services performed in an RHC, providers must use the national place of service code (POS) 72. An FQHC provider must use modifier EP when submitting claims for all THSteps visits in addition to the modifiers used to identify who performed the medical check up.
Condition indicators must be used to describe the results of the check up. A condition indicator must be entered on the claim with the periodic medical check up visit procedure code. Indicators are required whether a referral was made or not.
If a referral was made, providers must use the Y referral indicator. If no referral is made, providers must use the N referral indicator.
Modifiers AM, SA, TD, and U7 must be used to indicate the practitioner who performed the unclothed physical examination during the medical check up.
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