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December 2016 Texas Medicaid Provider Procedures Manual

Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook : 9 Physician : 9.2 Services, Benefits, Limitations, and Prior Authorization : 9.2.25 Developmental and Neurological Assessment and Testing : 9.2.25.2 Developmental Screening

9.2.25.2
Developmental screening using a recommended standardized screening tool (procedure code 96110) is a benefit of Texas Medicaid for clients who are birth through 20 years of age. Separate reimbursement for developmental screening completed without the use of one of the recommended standardized screening tools is not a benefit.
Developmental screening is limited to once per rolling year, any provider, outside of a THSteps medical checkup when medically necessary. This screening should only be completed for a diagnosis of suspected developmental delay or to evaluate a change in the client’s developmental status outside of a THSteps medical checkup.
Developmental screening should be used to identify clients who are birth through 6 years of age and who may need a more comprehensive evaluation. Results of developmental screening may guide or identify the need for further testing. Clients who have abnormal screening results must be referred to an appropriate provider for further testing. Clients who are birth through 35 months of age with suspected developmental delay must be referred to Texas Early Childhood Intervention (ECI) within 48 hours.
Refer to:
Subsection 2.7, “Early Childhood Intervention (ECI) Services,” in the Children’s Services Handbook (Vol. 2, Provider Handbooks) for additional information on the Texas ECI program.
Subsection 5.3.11.1.2, “Developmental Surveillance or Screening,” in the Children’s Services Handbook (Vol. 2, Provider Handbooks) for additional information on developmental screening for THSteps checkups.
Standardized screening (procedure code 96110) is not a benefit when completed to meet day care, Head Start, or school program requirements unless completed during an acute care visit in a clinic setting.

Texas Medicaid & Healthcare Partnership
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