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Update to Children’s Services Handbook Texas Health Steps Medical Checkups

Last updated on 12/14/2018

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 February 1, 2019, TMHP will update the Texas Medicaid Provider Procedures Manual, Volume 2, Children’s Services Handbook, subsection 5.3.6 “Texas Health Steps Medical Checkups,” to remove the referral indicator requirement and replace it with a referral status for checkups.

The required condition indicators determine the results of the referral status during a THSteps medical checkup. Referral indicators are no longer required.

The following statement and table heading will be updated in the handbook section:

The following table includes the procedure codes, required condition indicators, and the resulting referral status for medical checkups. A condition indicator must be submitted on the claim with the periodic medical checkup procedure code. Condition indicators are required whether a referral was made or not.

Procedure Codes

Condition Indicator

Referral Status

99381, 99382, 99383, 99384, and 99385 (new client preventive visit)

-or-

99391, 99392, 99393, 99394, and 99395 (Established client preventive visit)

NU (not used)

N (no referral given)

99381, 99382, 99383, 99384, and 99385 (new client preventive visit)

-or-

99391, 99392, 99393, 99394, and 99395 (established client preventive visit)

S2 (under treatment) or ST*

(new services requested)

Y (yes THSteps or EPSDT

referral was given to the client)

* The ST condition indicator should only be used when a referral is made to another provider or the client must be rescheduled for another appointment with the same provider. It does not include treatment initiated at the time of the checkup.

For more information, call the TMHP Contact Center at 800-925-9126.