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Texas Health Steps Flexibilities for Telemedicine (Audio-visual) and Telephone (Audio-only) Delivery Training Ending at End of PHE

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This article has been updated. To view the updated information, see “Multiple COVID-19 Flexibilities for Services Ending.”

Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, precertification, 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 with the end of the federal public health emergency (PHE), the Texas Health and Human Services Commission (HHSC) will end the temporary flexibility that has been allowed for Texas Health Steps (THSteps) checkups as described below. This article is intended to notify providers that this change will occur. When HHSC receives notice from federal authorities that the PHE is ending, an article will be issued to announce the end date.

To help ensure the continuity of care during the COVID-19 (coronavirus) response, HHSC authorized THSteps checkups for children 24 months and older through telemedicine (audio-visual) and telephone (audio-only) delivery during the COVID-19 PHE. This direction will remain in effect until the end of the PHE.

Telemedicine (audio-visual) and telephone (audio-only) checkup services are not permitted for children birth through 24 months of age (i.e., from newborn checkup through the “24-month” checkup). Telemedicine (audio-visual) delivery is preferred over telephone (audio-only) delivery. 

Effective for dates of service May 7, 2020, through the end of the federal PHE, HHSC has authorized Medicaid providers to submit claims for the following procedure codes, billed with modifier 95, for children over 24 months of age:

Description of Services

Procedure Codes

New Patient – THSteps Preventive Medical Checkup

99382, 99383, 99384, 99385

Established Patient – THSteps Preventive Medical Checkup

99392, 99393, 99394, 99395

All THSteps checkups completed as telemedicine (audio-visual) or telephone (audio-only) checkups require an in-person THSteps follow-up visit (procedure code 99211) within six months of the checkup date. Outstanding checkup components (i.e., immunizations and physical exams) that could not be completed during the telemedicine (audio-visual) or telephone (audio-only) checkups must be completed at the in-person follow-up visit. 

Effective on the last day of the federal PHE, THSteps checkup flexibilities permitting telemedicine (audio-visual) and telephone (audio-only) checkups will end. Providers completing THSteps checkups May 7, 2020, through the end of the federal PHE must ensure that all patients receive the required in-person THSteps follow-up visit. The THSteps follow-up visit must be completed within six months of the telemedicine checkup regardless of the end date of the PHE. For dates of service beginning the first day after the end of the federal PHE, THSteps providers will no longer be authorized to submit modifier 95 with the above procedure codes and will no longer be authorized to deliver a THSteps checkup by telemedicine (audio-visual) or telephone (audio-only).

Providers can refer to the Texas Medicaid Provider Procedures Manual, Children’s Services Handbook for additional information about the THSteps checkups and follow-up visits.

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