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Developmental Screening and Testing Benefit Limitation Language Updated for the CSHCN Services Program

Last updated on 3/13/2020

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.

Effective for dates of service on or after April 1, 2020, TMHP will update the Children with Special Health Care Needs (CSHCN) Services Program Provider Manual, Physician chapter, section, “Developmental Screening,” to clarify developmental screening and testing procedure codes 96110 and procedure code 96110 with modifier U6 benefit criteria.

For more information, call the TMHP-CSHCN Services Program Contact Center at 800-568-2413.