Table of Contents Previous Next

December 2016 Texas Medicaid Provider Procedures Manual

Children’s Services Handbook : 5 THSteps Medical : 5.3 Services, Benefits, Limitations, and Prior Authorization : 5.3.11 Mandated Components : 5.3.11.2 Comprehensive Unclothed Physical Examination

5.3.11.2
An age-appropriate unclothed physical examination is required at each checkup.
Recording of measurements and percentiles as appropriate to age to document growth and development including:
The World Health Organization (WHO) growth charts are recommended for clients from birth to 2 years of age.
The Centers for Disease Control and Prevention (CDC) growth charts are recommended for clients from 2 years of age and older.
5.3.11.2.1
Oral health screening is a part of the medical checkup physical examination.
5.3.11.2.2
Documentation of test results from a school vision or hearing screening program may replace the required audiometric or visual acuity screening if conducted within 12 months prior to the checkup.
Clients who are birth through 35 months of age with suspected or confirmed hearing or visual impairment must be referred to ECI as soon as possible, but no longer than 7 days after identification.
5.3.11.2.3
State-mandated newborn hearing screening is offered by and performed in the birth facility in accordance with Health and Safety Code (HSC), Chapter 47, §§ 47.001–47.009 and 25 TAC §§ 37.501–37.512.
The provider must review the results with the parent or caregiver at the first checkup and determine if any additional follow-up is necessary.
Hearing screening must be performed at each checkup. Audiometric screening must be performed at specific ages indicated on the periodicity schedule. Subjective screening through provider observation or informant report is done at the other checkups.
Clients at high risk or with abnormal screening results must be referred to an appropriate Medicaid-enrolled provider who specializes in pediatric audiology services. Clients who are birth through 20 years of age enrolled with Texas Medicaid for the date(s) of service are eligible for Texas Medicaid hearing services benefits.
5.3.11.2.4
Vision screening must be performed at each checkup. A visual acuity test must be performed at ages indicated on the periodicity schedule. Subjective screening through provider observation or informant report is done at the other checkups.
All clients must be screened for eye abnormalities by history, observation, and physical exam and referred to a Medicaid-enrolled optometrist or ophthalmologist experienced with the pediatric population if at high risk.
Clients with abnormal visual acuity screening results must be referred to a Medicaid-enrolled optometrist or ophthalmologist experienced with the pediatric population.

Texas Medicaid & Healthcare Partnership
CPT only copyright 2014 American Medical Association. All rights reserved.