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WARNING: THIS IS A TEXAS HEALTH AND HUMAN SERVICES INFORMATION RESOURCES SYSTEM THAT CONTAINS STATE AND/OR U.S. GOVERNMENT INFORMATION. BY USING THIS SYSTEM YOU ACKNOWLEDGE AND AGREE THAT YOU HAVE NO RIGHT OF PRIVACY IN CONNECTION WITH YOUR USE OF THE SYSTEM OR YOUR ACCESS TO THE INFORMATION CONTAINED WITHIN IT. BY ACCESSING AND USING THIS SYSTEM YOU ARE CONSENTING TO THE MONITORING OF YOUR USE OF THE SYSTEM, AND TO SECURITY ASSESSMENT AND AUDITING ACTIVITIES THAT MAY BE USED FOR LAW ENFORCEMENT OR OTHER LEGALLY PERMISSIBLE PURPOSES. ANY UNAUTHORIZED USE OR ACCESS, OR ANY UNAUTHORIZED ATTEMPTS TO USE OR ACCESS, THIS SYSTEM MAY SUBJECT YOU TO DISCIPLINARY ACTION, SANCTIONS, CIVIL PENALTIES, OR CRIMINAL PROSECUTION TO THE EXTENT PERMITTED UNDER APPLICABLE LAW.
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AMA/ADA End User License Agreement
LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT® ")

You, your employees and agents are authorized to use CPT only as contained in materials on the Texas Medicaid & Healthcare Partnership (TMHP) website solely for your own personal use in directly participating in healthcare programs administered by THHS. You acknowledge that AMA holds all copyright, trademark and other rights in CPT.

Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to use CPT for any use not authorized herein must be obtained through the American Medical Association, Intellectual Property Services, 515 N. State Street, Chicago, Illinois, 60610. Applications are available at the American Medical Association website, www.ama-assn.org/go/cpt.

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This product includes CPT which is commercial technical data and/or computer databases and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer databases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (November 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements.

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1. Subject to the terms and conditions contained in this Agreement, you, your employees and agents are authorized to use CDT only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. Use of CDT is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. You acknowledge that the ADA holds all copyright, trademark and other rights in CDT. You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights included in the materials.

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3. U.S. GOVERNMENT RIGHTS. Applicable Federal Acquisition Regulation Clauses (FARS)\Department of Defense Federal Acquisition Regulation Supplement (DFARS) Restrictions Apply to Government Use. This product includes CDT, which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable, which was developed exclusively at private expense by the American Dental Association, 211 East Chicago Avenue, Chicago Illinois, 60611. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal Procurements.

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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

Last updated on 7/18/2022

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.