COVID-19: THSteps Remote Delivery of Medical Checkups – Texas Medicaid

Revised February 1, 2022

What is changing?

Per Texas Health Steps (THSteps) and Texas Health and Human Services Commission (HHSC), we are extending the end date for remote delivery of medical checkups for THSteps through April 30, 2022. During this time, telemedicine and telephone delivery for certain components of THSteps checkup are allowed. This applies only to children over 24 months of age. Providers must use their own judgment to determine which checkup component(s) are appropriate for telemedicine or telephone delivery.

We are continuing to evaluate the evolving state and federal legislative and regulatory landscape relating to COVID-19 and will continue to update our practices accordingly.

What are the requirements?

The federally-mandated components by THSteps require the following for medical checkups:

1. Comprehensive health and developmental history, including physical and mental health and development
2. Comprehensive unclothed physical examination
3. Immunizations appropriate for age and health history
4. Laboratory tests appropriate to age and risk, including lead toxicity screening
5. Health education, including anticipatory guidance

If a provider uses telemedicine or telephone delivery for one of the THSteps components, the provider must complete all other components (i.e. immunizations and physical exams) with an in-person visit within six months of the telemedicine visit or telephone delivery.

Does this apply to everyone?

No. THSteps checkups for children from birth through 24 months of age are not permitted to deliver visits by telemedicine or telephone-only service.

How to bill:

• Use the appropriate initial visit as currently required by THSteps checkups.
• Add-on codes may be billed (e.g. developmental screening, mental health screening, etc.).
• Must use modifier 95 and place of service 02 when delivering remotely.
• Any component that was not completed during the initial checkup, use COVID-19 as the reason for incomplete checkup.
• Use follow-up visit code 99211 for patients who are unable to complete any outstanding components and are seen within the six-month timeframe.
• THSteps checkup codes reimbursement will be identical to current rates.
• These guidelines apply to both new and established patients for both managed care and fee-for-service Medicaid.

Three-Day Medical Exam:

• The Texas Department of Family Protective Services (DFPS) requires a three-day medical exam for children entering DFPS conservatorship. Telemedicine or telephone-only delivery is not permitted, regardless of age, with one exception:
  • Remote delivery is allowed IF a child requires quarantine or isolation at the time of removal due to COVID-19 exposure or diagnose as infected. Telemedicine, telehealth or telephone-only will be allowed to avoid the risk of transmission in a health care setting. Providers must document the detail circumstances which necessitated remote delivery. Providers must use modifier 95 and place of service 02 for claims.

Additional Information:

The American Academy of Pediatrics (AAP) recommends strategies to ensure children over two years old receive age- appropriate vaccines in a timely manner. For example, a curbside/drive-through immunization clinic is recommended to ensure children receive vaccines in a timely manner.

As a reminder, a patient’s home is not excluded as a THSteps site of service for medical checkups.

Resources

Reference and review the BCBSTX Preventive Care Guidelines (PCGs), Clinical Practice Guidelines (CPGs), and THSteps for Medical Providers which includes all current vaccine schedules, ImmTrac2, and other important guidance for treating your patients.

Have questions?

Contact the Blue Cross and Blue Shield of Texas (BCBSTX) Medicaid provider call center at 1-877-560-8055 or contact your BCBSTX Medicaid Provider Network Representative at 1-855-212-1615.

For more information about this notice and other changes to Texas Medicaid due to COVID-19, visit the TMHP website.