Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, pre-certification, referrals, and claims/encounter data filing may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the client's specific MCO for details.
Beginning November 1, 2018, TMHP will update the Texas Medicaid Provider Procedures Manual, Children’s Services Handbook, Section 5.3.6, “THSteps Medical Checkups,” to include additional reimbursement information about postpartum depression screenings.
The following statements will be updated as follows:
- Components of a medical checkup that have an available Current Procedural Terminology (CPT) code are not reimbursed separately on the same day as a medical checkup, with the exception of initial point-of-care blood lead testing, mental health screening for adolescents, postpartum depression screening, a tuberculin skin test (TST), developmental and autism screening, vaccine administration, and oral evaluation and fluoride varnish (OEFV).
- THSteps medical checkups performed in an Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC) setting are paid an all-inclusive rate per encounter, which includes immunizations, developmental screening, autism screening, mental health screening for adolescents, postpartum depression screening, tuberculin skin test (TST), initial point-of-care blood lead test, and oral evaluation and fluoride varnish (OEFV).
For more information, call the TMHP Contact Center at 800-925-9126.