NOTICE: Caries Risk Assessment Now Mandatory; Training Available: Beginning October 1, 2015, Texas Health Steps requires caries risk assessment and documentation to be included in all dental exams. Beginning January 1, 2016, dental exams will be denied for reimbursement by Medicaid unless caries risk assessment is properly conducted, documented, and coded.
DSHS offers free online training with step-by-step guidance about conducting and documenting caries risk assessment for patients ages 6 months through 20 years. The training provides links to all caries risk assessment forms and includes documentation and billing information. Get a head start on this new requirement and take the training today by linking to the PowerPoint shown below.
Promoting Oral Health through Caries Risk Assessment and Dental Anticipatory Guidance [PDF 7.74MB]
PERIODICITY SCHEDULE - See CURRENT NOTICES section below for information on Texas Health Steps policy changes effective November 1, 2015. The Texas Health Steps Medical Checkup Periodicity Schedule for infants, children, and adolescents (birth through 20 years of age) has been revised to reflect policy changes effective April 1, 2015. The revised schedule reflects a change to autism screening requirements using the M-CHAT. Place an order online or download LARGE version in Color [PDF 72KB] and Black & White [PDF 132KB] or POCKET-SIZED in Color [PDF 152KB] and Black & White [PDF 156KB]. (You may need to adjust print settings to select "Actual size" under "Page Sizing & Handling"). Please contact a THSteps Provider Relations Representative for additional information.
Anticipatory Guidance-A Guide for Providers has been designed specifically for THSteps providers. It offers age-appropriate anticipatory guidance topics for children birth through 20 years of age.
ADOLESCENT HEALTH GUIDE - Designed for health-care providers and other professionals who provide services, information, and support to young people. It offers guidelines on health and health-related legal issues pertinent to the adolescent years. Adolescent Health-A Guide for Providers [PDF 3.38MB] Updated March 2015 Text Only Please Note: Printed versions of the Adolescent Health Guide dated between August 2011 and February 2015 should be updated by printing INSERT 1 [PDF 308KB] to place behind the front cover, and INSERT 2 [PDF 84KB] to replace Page 14.
Texas Health Steps Policy Change effective November 1, 2015 - Benefit criteria for Texas Health Steps medical checkups will change for dates of service on or after November 1, 2015.
Diagnosis Codes – Diagnosis codes Z0000 and Z0001 will be added as payable diagnosis codes for procedure codes 99385 and 99395.
Laboratory Screening - Age-appropriate and risk-based laboratory testing as noted on the periodicity schedule is considered part of the medical checkup.
- Anemia screening- removal of the mandatory screenings at ages 18 months and females at 12 years of age, leaving the mandatory screening at 12 months of age only.
- Human Immunodeficiency Virus (HIV) screening- to add to the current risk based screening for ages 11 through 20 years, the mandatory requirement to screen once between the ages of 16 to 18 years of age, regardless of risk.
- Dyslipidemia Screening (previously hyperlipidemia screening)-to add to the current risk based screening for clients 24 months to 20 years of age, mandatory screening requirements once for all clients between the ages of 9-11 years of age and again for all clients between the ages of 18-20 years of age, regardless of risk.
Autism Screening - The Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT R/F) may also be used to complete the required autism screening at 18 and 24 months of age.
Mental Health Screening – Mental health screening is a required component at each checkup birth through 20 years of age. Mental health screening using one of the following validated, standardized mental health screening tools recognized by THSteps is required once for all clients who are 12 through 18 years of age:
- Pediatric Symptom Checklist (PSC-35)
- Pediatric Symptom Checklist for Youth (Y-PSC)
- Patient Health Questionnaire (PHQ-9)
- Car, Relax, Alone, Forget, Family, and Trouble Checklist (CRAFFT)
Procedure code 99420 must be submitted for mental health screenings when one of the validated, standardized mental health screening tools recognized by THSteps is used. Procedure code 99420 must be submitted on the same date of service by the same provider as procedure code 99384, 99385, 99394, or 99395, and will be limited to once per lifetime. Providers may be separately reimbursed when screening is completed using one of the required tools. The client’s medical record must include documentation identifying the tool that was used, the screening results, and any referrals that are made. Mental health screening at other checkups does not require the use of a validated, standardized mental health screening tool.
Newborn Screening - State-mandated newborn screening for critical congenital heart disease (CCHD) is offered by and performed in the birth facility in accordance with Health and Safety Code (HSC), Chapter 33, §§ 33.011, and the Texas Administrative Code (TAC), Title 25, Part 1, Chapter 37, Subchapter E, §§ 37.75 - 37.79.
Telemedicine/Telehealth Services - THSteps preventive care medical checkups are not a benefit as a telemedicine or telehealth service.
Texas Health Steps Policy Changes Effective April 1, 2015
ICD-10-CM Coding for Texas Health Steps
On October 1, 2015 the International Classification of Disease, Tenth Revision, Clinical Modification (ICD-10-CM) will implement. Effective for dates of service on or after October 1, 2015, codes Z00129 and Z00121 will replace ICD-9 - CM diagnosis code V202 for medical checkups, exception to periodicity checkups and follow-up visits. Effective November 1, 2015, diagnosis codes Z0000 and Z0001 will be added as new codes for medical checkups, exception to periodicity checkups, and follow-up visits for clients 18 to 20 years of age.
|ICD-10 - CM Code
||Encounter for routine child health examination without abnormal findings
||Encounter for routine child health examination with abnormal findings
||Encounter for general adult medical examination without abnormal findings
||Encounter for general adult medical examination with abnormal findings
Additional information on ICD-10 - CM changes and claims information can be found at http://www.tmhp.com/Pages/CodeUpdates/ICD-10.aspx and in the Texas Medicaid Provider Procedures Manual Children’s Services Handbook, Subsection 5.5.1, “Claims Information”.
HHSC has developed a new web page where proposed Medicaid policy changes will be listed. The page also explains how to comment on the changes and allow people to recommend new medical and dental benefits. Click on "Sign up for e-mail updates" on that page to subscribe to email updates to the page.
Federal Re-enrollment - Texas Medicaid must comply with federal regulations which require all providers to revalidate their enrollment information every three to five years. In accordance with this mandate, the Centers for Medicare & Medicaid Services (CMS) require that states complete the initial re-enrollment of all providers by March 24, 2016. For Texas Medicaid, any provider enrolled before January 1, 2013, must be fully re-enrolled by March 24, 2016. Providers can begin this process immediately.
DSHS is pleased to announce the expansion of the Texas Newborn Screening Panel to include secondary conditions of the Recommended Uniform Screening Panel. Screening is anticipated to begin in mid-2015. DSHS will continue to provide updates throughout the implementation process. Link to Newborn Screening Notices for more information.
DSHS News Releases
FLU - www.texasflu.org/
Influenza Information for Health Care Professionals
Anticipatory Guidance Resource List [PDF 112KB] Text Only
Asthma-Guidelines for Diagnosis and Management
Parent Health Care Guide - Designed for families to help in determining the appropriate level of health care needed for different illnesses and or injuries. [PDF 3.42MB]
Contact Information-THSteps Provider Relations / Oral Health Program
Critical Congenital Heart Disease (CCHD) reporting became mandatory in Texas on September 1, 2014. Please go to the Newborn Screening website at www.dshs.state.tx.us/newborn/ for complete information on CCHD screening and reporting in Texas, and to access the CCHD toolkit.
Developmental Calendar - "A Parent's Guide to Raising Healthy, Happy Children"
Developmental Screening Forms
DFPS Medical Services
Information for Health and Medical Professionals Referring To Early Childhood Intervention (ECI)
Frequently Asked Questions (FAQ)s
IMPROVE - Please note that HHSC is currently restructuring the provider feedback process and allowing providers to directly connect with specific areas that interact with clients on a daily basis. Log on to HHSC's IMPROVE web page for complete information.
Your Texas Benefits Medicaid Card and Provider Website - Information on the Medicaid ID card and Medicaid eligibility verification website.
Medical Transportation Program - HHSC
Medical Transportation Program Tutorial (Link online at txhealthsteps.com)
Mental Health Screening Tools Recommended based on Release of 2014 AAP Preventive Pediatric Health Care Recommendations
Modifier 25 Frequently Asked Questions [PDF 92KB]
Parent Companion: First Five Years - Texas Education Agency, Region XIII Education Service Center, and Texas Parent to Parent (TxP2P) unveiled a new online resource for parents of young children. The website features information for parents and caregivers of children with diagnosed or suspected disabilities from birth through 5 years of age.
Provider Outreach Referral Service
THSteps and How It Works
DSHS Immunization Branch
CDC's Immunization Schedule
Information on Vaccine Shortages
THSteps Medical Checkup Laboratory Requirements [PDF 43KB] Text only
DSHS Laboratory Checklist for THSteps Medical Providers [PDF 46KB] Text only
Texas Health Steps Risk Based Guidance Tool Color [PDF 304KB] B&W [PDF 304KB] Text only
Newborn Screening (NBS) Laboratory
NBS Laboratory NOTICES
Information Regarding Blood Spot Card Storage and Use
Clinical Chemistry Remote Data Services
DSHS Laboratory Home Page
Lab Supply Order Information - Includes the G-THSTEPS Specimen Submission Form (Scroll to bottom of that page to find information on how to obtain the G-THSTEPS form via email or phone)
Serum Specimen Criteria
Specimen Collection and Handling
LabGuides Tutorials - LabGuides are short tutorials designed to help providers meet the acceptance criteria for certain specimens sent to the DSHS Laboratory.
THSteps Preventive Care Medical Checkup Requirement for Elevated Blood Levels - In accordance with Texas Administrative Code (TAC) Title 25 (Part 1) Chapter 37 Subchapter Q Rule §37.334, the elevated blood lead level requirement has been reduced from 10 mcg/dL to 5 mcg/dL. For an elevated blood lead level of 5 mcg/dL or greater, the provider must perform a confirmatory test using a venous specimen. The confirmatory specimen may be sent to the Department of State Health Services (DSHS) Laboratory, or the client or specimen may be sent to a laboratory of the provider’s choice.
Information related to blood lead screening and reporting for clients who are 15 years of age and older is available on the DSHS Blood Lead Surveillance Group’s website at www.dshs.state.tx.us/lead/providers.shtm.
Texas Childhood Lead Poisoning Prevention Program (TXCLPPP)
Texas Medicaid Program HHSC Internet
Texas Medicaid Provider Procedures Manual (TMPPM)-The TMPPM will be updated monthly with policy and procedure changes that were implemented at the beginning of the previous month. The updated chapters will be published around the 15th of each month. The manual is available on the TMHP website on the Texas Medicaid Provider Procedures Manual Website Page and can be accessed by clicking the Reference Material button on any web page in the Texas Medicaid provider section.
TMHP Texas Health Steps Page (The THSteps Quick Reference Guide and other helpful information can be found on this TMHP internet page)
Best Practices in Delivering Medicaid Services
Medicaid and CHIP Statistics
Periodicity Schedule (Posted at top of page)
Online Provider Education (OPE)-Continuing Education (CE) Hours - Texas Health Steps' award-winning online program offers FREE CE Courses to enhance your ability to provide preventive health, mental health, oral health and case management services to Medicaid eligible children in Texas. First time users will need to register.
UNAUTHORIZED WEBSITE ADVISORY: Please be advised that there is a separate, privately owned and operated website located at http://ww42.texashealth steps.com that is not authorized, or affiliated with, Texas Health Steps, DSHS, or any of the Texas Health and Human Services agencies, which do not approve of the website or endorse any of its contents. Contact email@example.com if you have questions.
TMHP Provider Education Home Page - This is the homepage for all of the provider education opportunities offered by TMHP. Providers can run computer-based training (CBT) modules, register for workshops and webinars, listen to or read transcripts of past webinars or Radio TMHP offerings, and access written workshop materials. To view a CBT, you must be registered on the Learning Management System (LMS) server.
Vendor Drug Program-Pharmacy Continuing Education
Ages & Stages Questionnaires®
Case Management for Children & Pregnant Women
Children's Health Insurance Program (CHIP)
Developmental Behavioral Pediatrics Online
Early Childhood Intervention (ECI)
Oral Health Program
Spinal Screening Program
Texas Medicaid and Healthcare Partnership (TMHP)
Texas Medicaid Vendor Drug Program
Texas Women's Health Program
Vision and Hearing Screening
WIC - Special Supplemental Nutrition Program for Women, Infant and Children