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Texas Health Steps Preventive Care Medical Checkups Through Synchronous Audiovisual or Synchronous Telephone (Audio-only) to Be Allowed During a State of Disaster

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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.

On September 1, 2022, the Texas Medicaid & Healthcare Partnership (TMHP) will update the Texas Medicaid Provider Procedures Manual, Children’s Services Handbook with synchronous audiovisual and synchronous telephone (audio-only) technology criteria to allow telemedicine and telehealth services for Texas Health Steps preventive care medical checkups during a declaration of a state of disaster.

Medical Checkups During a Declaration of a State of Disaster

During a declaration of a state of disaster, HHSC may issue direction to providers regarding the use of telemedicine and telehealth services to include the use of a synchronous telephone (audio-only) platform to provide covered services outside the allowances described herein to the extent permitted by Texas law. A declaration of a state of disaster occurs when an executive order or proclamation is issued by the governor declaring a state of disaster in accordance with Section 418.014 of the Texas Government Code.

The following limitations apply to all Texas Health Steps preventive medical checkups and all exception-to-periodicity checkups during a declaration of a state of disaster when HHSC issues direction on the use of synchronous audiovisual and synchronous telephone (audio-only) technologies:

  • Clients who are 2 years of age through 20 years of age may receive a Texas Health Steps medical checkup or exception-to-periodicity checkup using synchronous audiovisual or synchronous telephone (audio-only) technologies.
  • Clients from birth through 2 years of age may not receive a Texas Health Steps checkup or exception-to-periodicity checkup using synchronous audiovisual or synchronous telephone (audio-only) technologies.
  • Clients from birth through 24 months of age must receive in-person checkups.

A medical checkup provided using synchronous audiovisual or synchronous telephone (audio-only) technologies must be completed according to the age-specific checkup requirements listed on the Texas Health Steps periodicity schedule.

Synchronous audiovisual delivery for medical checkups is preferred over synchronous telephone (audio-only) delivery.

An in-person Texas Health Steps follow-up visit must be completed within six months of the synchronous audiovisual or synchronous telephone (audio-only) checkup for the checkup to be considered a complete Texas Health Steps checkup.

When HHSC issues direction, the following Texas Health Steps medical checkup services are authorized for delivery using synchronous audiovisual or synchronous telephone (audio-only) technologies during a declaration of a state of disaster:

Procedure Codes

99382*

99383

99384

99385

99392*

99393

99394

99395

       

*Limited to checkups for clients who are over 24 months of age and who received their 24-month checkup in person.

Medical checkups and exception-to-periodicity checkups provided using synchronous audiovisual or synchronous telephone (audio-only) technologies are limited to checkups for clients who are 2 years of age or older for the following procedure codes:

Procedure Codes

99382

99382

99384

99385

99392

99393

99394

99395

       

Medical checkups for clients who are 2 years of age or younger must be completed in person and may not be completed using synchronous audiovisual or synchronous telephone (audio-only) technologies for the following procedure codes:

Procedure Codes

99381

99382

99391

99392

   

Texas Health Steps providers should use their clinical judgment about which checkup components may be appropriate for completion using synchronous audiovisual or synchronous telephone (audio-only) technologies.

Texas Health Steps providers should ensure that clients getting a medical checkup through synchronous audiovisual or synchronous telephone (audio-only) technologies receive age-appropriate vaccines and laboratory screenings in a timely manner.

Medical checkup services using synchronous audiovisual or synchronous telephone (audio-only) technologies should be provided only if agreed to by the client or parent/guardian.

Texas Health Steps Required Follow-up Visit

An in-person follow-up visit (procedure code 99211) is required for all clients who receive an initial synchronous audiovisual or synchronous telephone (audio-only) checkup.

The in-person follow-up visit is required within six months of the synchronous audiovisual or synchronous telephone (audio-only) checkup.

All age-appropriate checkup components listed on the Texas Health Steps Periodicity Schedule that are not completed during the synchronous audiovisual or synchronous telephone (audio-only) checkup must be completed at the in-person follow-up visit.

Documentation Requirements

Documentation in the client’s medical record for synchronous audiovisual or synchronous telephone (audio-only) checkups must meet all the documentation requirements for an in-person checkup and include all of the following:

  • Whether the checkup was completed using synchronous audiovisual or synchronous telephone (audio-only) technology
  • All checkup components that were not completed at the time of the synchronous audiovisual or synchronous telephone (audio-only) checkup, the reason that the components were not completed, and a plan to complete the components
  • For the required in-person Texas Health Steps follow-up visit: documentation that the visit is related to a previously provided synchronous audiovisual or synchronous telephone (audio-only) checkup or exception-to-periodicity checkup
  • For the required in-person Texas Health Steps follow-up visit: documentation of all age-appropriate checkup components completed during the visit
  • All anticipatory guidance and information on the next scheduled medical checkup or follow-up visit

Reimbursement

Texas Health Steps checkups billed as synchronous audiovisual or synchronous telephone (audio-only) checkups (procedure codes 99381, 99382, 99391, or 99392) for clients who are 24 months of age or younger will be denied.

Texas Health Steps checkups and exception-to-periodicity checkups delivered through synchronous audiovisual technology must be billed with modifier 95.

Texas Heath Steps checkups and exception-to-periodicity checkups delivered through synchronous telephone (audio-only) technology must be billed using modifier 93.

Checkups billed as exception-to-periodicity checkups must also include the appropriate exception-to-periodicity checkup modifier (modifier 23, 32, or SC).

Records are subject to retrospective review, and incomplete checkups are subject to recoupment.

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