What are the rules for billing Texas Health Steps (THSteps) checkups?
Texas Health Steps (THSteps) is the Texas Medicaid name for federal EPSDT (Early and Periodic Screening, Diagnostic, and Treatment) services. To bill a complete THSteps medical checkup, providers use age-appropriate preventative medicine CPT codes (99381-99385 for new patients, 99391-99395 for established patients) appended with modifier -EP. All core screening components—comprehensive physical exam, developmental/behavioral screening, vision and hearing acuity, dental referral, lead screening, and nutritional assessment—must be fully documented in the medical record. State-supplied Vaccines for Children (VFC) must be billed with $0.00 charge, billing only the administration codes (90460/90461 or 90471/90472).
1. Core Components of a Complete THSteps Checkup
Texas Medicaid requires that every THSteps checkup include six essential elements. Omitting even one element during an HHSC chart audit can result in total recoupment of the checkup fee:
1. Comprehensive health and developmental history.
2. Comprehensive unclothed physical examination.
3. Age-appropriate vision and hearing screenings.
4. Oral health exam and direct referral to a dental home starting at 6 months of age.
5. Laboratory tests including mandatory blood lead testing at 12 and 24 months.
6. Immunization assessment and administration of indicated VFC vaccines.
2. Billing Vaccines for Children (VFC) Correctly in Texas
Avoiding claim rejections for state-provided immunizations
Texas pediatric practices receive vaccines free from the DSHS VFC program. In medical claims:
• Submit the specific CPT vaccine code (e.g. 90700 for DTaP) with a billed charge of $0.00 or $0.01 depending on clearinghouse settings.
• Bill the administration code: 90460 for physician/staff counseling for the first component, and 90461 for each additional vaccine component.
• Append modifier -EP to the administration codes to designate an EPSDT service.