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2012 Texas Medicaid Provider Procedures Manual

Children’s Services Handbook : 5. THSteps Medical : 5.3 Services, Benefits, Limitations, and Prior Authorization

5.3 Services, Benefits, Limitations, and Prior Authorization
Through outreach, THSteps staff (DSHS, HHSC, or contractors) encourage clients to use THSteps preventive medical checkup services when they first become eligible for Medicaid and each time thereafter when they are periodically due for their next medical checkup. THSteps will send clients a letter when they are due for a medical checkup.
Providers are encouraged to perform checkups on any client they identify as due for medical checkups. They also are encouraged to notify clients when they are due for the next checkup according to the THSteps periodicity schedule.
A client is due for a medical checkup as determined by the client's age on the first day of the month. If a client's birthday is not on the first of a month, the client will not be due until the first day of the following month. If a client turns 21 years of age during a month, the client continues to be eligible for THSteps services through the end of that month.
Checkups that are necessary when a THSteps statement does not indicate a medical checkup is due must be billed as an exception to the periodicity checkup.
Refer to:
Subsection 5.3.5, “Exception-to-Periodicity Checkups” in this handbook for additional details about billing for a checkup performed as an exception-to-periodicity checkup.
Although the Medicaid Eligibility Verification Letter (Form H1027) identifies eligible clients when the client's Your Texas Benefits card is lost or has not yet been issued, Form H1027 does not indicate if the client is due for medical checkup services. Providers can verify the client's eligibility through, TexMedConnect, or the TMHP Contact Center.

Texas Medicaid & Healthcare Partnership
CPT only copyright 2011 American Medical Association. All rights reserved.