Texas Health Steps Medical Checkups
99381 99382 99383 99384 99385*
99391 99392 99393 99394 99395*
* For clients who are 18 through 20 years of age, use diagnosis code Z0000 or Z0001.
Texas Health Steps Follow-up Visit
Use procedure code 99211 for a Texas Health Steps follow-up visit.
ICD-10 Diagnosis Codes
Z00110 Routine newborn exam, birth through 7 days
Z00111 Routine newborn exam, 8 through 28 days
Z00129 Routine child exam
Z00121 Routine child exam, abnormal
Z0000 General adult exam
Z0001 General adult exam, abnormal
Immunizations Administered
Use code Z23 to indicate when immunizations are administered.
Procedure Codes Vaccine
90380
†
or 90381
†
with (96380 or 96381) RSV
90619
†
with (90460/90461 or 90471/90472) MenACWY-TT
90632 or 90633
†
with (90460/90461 or 90471/90472) Hep A
90620
†
or 90621
†
with (90460/90461 or 90471/90472) MenB
90623
†
with (90460/90461 or 90471/90472) MenABCWY
90636 with (90460/90461 or 90471/90472) Hep A/Hep B
90647
†
or 90648
†
with (90460/90461 or 90471/90472) Hib
90651
†
with (90460/90461 or 90471/90472) HPV
90630, 90654, 90655
†
, 90656
†
, 90657
†
, 90658
†
, 90685
†
,
90686
†
, 90687
†
or 90688
†
with (90460/90461 or
90471/90472); 90660
†
or 90672
†
with (90460/90461 or
90473/90474); 90661, 90673, 90674, 90682 or 90756
†
with
(90471/90472)
Inuenza
90670
†
with (90460/90461 or 90471/90472) PCV13
90671
†
with (90460/90461 or 90471/90472) PCV15
90677
†
with (90460/90461 or 90471/90472)
PCV20
90678
†
with (90460/90461 or 90471/90472 RSV
90680
†
or 90681
†
with (90460/90461 or 90473/90474) Rotavirus
90696
†
with (90460/90461 or 90471/90472) DTaP-IPV
90697
†
or 90698
†
with (90460/90461 or 90471/90472) DTap-IPV-Hib
90700
†
with (90460/90461 or 90471/90472) DTaP
90702
†
with (90460/90461 or 90471/90472) DT
90707
†
with (90460/90461 or 90471/90472) MMR
90710
†
with (90460/90461 or 90471/90472) MMRV
90713
†
with (90460/90461 or 90471/90472) IPV
90714
†
with (90460/90461 or 90471/90472) Td
90715
†
with (90460/90461 or 90471/90472) Tdap
90716
†
with (90460/90461 or 90471/90472) Varicella
90723
†
with (90460/90461 or 90471/90472) DTap-Hep B-IPV
90732
†
with (90460/90461 or 90471/90472) PPSV23
90734
†
with (90460/90461 or 90471/90472) MPSV4
90739, 90743, 90744
†
, 90746 , or 90759 with (90460/90461 or
90471/90472)
Hep B
90758 with (90471/90472) Ebola Virus
91304
†
, 91318
†
, 91319
†
, 91320
†
, 91321
†
, or 91322
†
with
(90480/M0201)
COVID-19
Oral Evaluation and Flouride Varnish
Use procedure code 99429 with U5 modier.
Developmental and Autism Screening
Developmental screening with use of the ASQ, ASQ:SE, PEDS or SWYC is reported
using procedure code 96110.
Autism screening with use of the M-CHAT or M-CHAT R/F is reported using
procedure code 96110 with U6 modier.
Tuberculin Skin Testing (TST)
Use procedure code 86580 for TST. Procedure code 86580 may be reimbursed on
the same day as a checkup.
Mental Health Screening
Mental Health Screening in adolescents with the use of the PSC 17, PSC-35, Y-PSC,
PHQ-9, PHQ-A (depression screen), CRAFFT, PHQ-A (Anxiety, mood, substance
use) or RAAPS is reported using procedure code 96160 or 96161. Only one
procedure code (96160 or 96161) may be reimbursed per client per calendar year.
Postpartum depression screening with the use of a validated screening tool including
the Edinburgh Postnatal Depression Scale, PHQ-9 or Postpartum Depression
Screening Scale is reported using procedure code G8431 or G8510. Only one procedure
code (G8431 or G8510) may be reimbursed per client.
Condition Indicator Codes
One of the Condition Indicators below is required whether a referral was made or
not.
Referral Status Indicator Codes Description
N NU Not used (no referral)
Y ST New services requested
Y S2
Under treatment
Point-of-Care Lead Testing
Use procedure code 83655 with QW modier to report that an initial blood lead level
screening test was completed using point-of-care testing.
Modiers
Performing Provider
Use to indicate the practitioner who is performing the unclothed physical
examination component of the medical checkup.
AM (Physician) SA (Nurse
Practitioner)
TD (Nurse) U7 (Physician
Assistant)
Exception to Periodicity
Use with Texas Health Steps medical checkups procedure codes to indicate the
reason for an exception to periodicity.
23 (Unusual
Anesthesia)
32 (Mandated Services) SC (Medically Necessary)
FQHC and RHC
Federally qualied health center (FQHC) providers must use modier EP for Texas
Health Steps medical checkups. Rural health clinic (RHC) providers must bill place of
service 72 for Texas Health Steps medical checkups.
Vaccine/Toxoids
Use to indicate a vaccine/toxoid not available through TVFC and the number of
state dened components administered per vaccine.
U1 Vaccine/toxoid privately purchased by provider when TVFC vaccine/
toxoid is not available
Vaccine Administration and Preventive E/M Visits
Use with Texas Health Steps preventive visit checkup procedure codes to indicate a
signicant, separately identiable E/M service that was rendered by the same provider
on the same day as the immunization administration.
25 Signicant, separately identiable evaluation
Texas Health Steps Quick Reference Guide
Texas Health Steps Quick Reference Guide - revised 07/01/2024 1
Remember: Use Provider Identier • Use Benet Code EP1
Texas Health Steps Medical Checkup Billing Procedure Codes
†
Indicates a vaccine distributed by TVFC
Contact Information
Texas Health Steps Medical Checkup Claims Inquiries
Call 800-757-5691 to obtain answers to questions or determine the status
of claims. For managed care clients, contact the client’s MCO.
Texas Health Steps Website
General information for providers including forms, details on the required
components of checkups, and other helpful resources.
hhs.texas.gov/doing-business-hhs/provider-portals/health-services-
providers/texas-health-steps
Texas Health Steps Child Health Record Forms and Texas Health Steps
Provider Outreach Referral Form may be downloaded from:
hhs.texas.gov/doing-business-hhs/provider-portals/health-services-
providers/texas-health-steps/forms
Online catalog of Texas Health Steps publications:
hhs.texas.gov/doing-business-hhs/provider-portals/health-services-
providers/texas-health-steps/thsteps-catalog
Texas Health Steps Outreach & Informing Service
Information for Texas Health Steps clients to expand awareness of existing
medical, dental, and case management services. Provider information to
include missed appointment referral services.
877-THSteps (847-8377), Monday to Friday, 8am-6pm
Texas Health Steps Online Provider Education Website
Free comprehensive online continuing education modules designed for
health-care providers. All modules provide continuing education units
(CEUs) for multiple disciplines and include information about Texas Health
Steps, Medicaid for children and other health-care services.
txhealthsteps.com
Case Management for Children and Pregnant Women
512-776-2168
hhs.texas.gov/doing-business-hhs/provider-portals/health-services-
providers/case-management-providers-children-pregnant-women
Texas Immunization Registry (ImmTrac2)
800-348-9158 | dshs.texas.gov/immunize/immtrac/default.shtm
Texas Vaccines for Children Program (TVFC)
800-252-9152 | dshs.texas.gov/immunizations/providers/overview
Vendor Drug Program (fee-for-service)
e Medicaid Vendor Drug Program makes payments to contracted
pharmacies for prescriptions of covered outpatient drugs for Texas
Medicaid, CSHCN Services Program, Kidney Health Care Program, and
CHIP. Some Medicaid-covered drugs may require prior authorization (PA)
through PA Texas.
Texas Prior Authorization Call Center: 877-728-3927
or online: https://paxpress.txpa.hidinc.com
(for prior authorizations of non-preferred drugs only)
General information, covered drug list, online pharmacy, and prescriber
searches:
txvendordrug.com
txvendordrug.com/about/manuals/pharmacy-provider-procedure-
manual
For managed care clients: Contact the client’s MCO.
Comprehensive Care Program (CCP)
Telephone: 800-846-7470 | Fax: 512-514-4212
Early Childhood Intervention (ECI)
800-628-5115 | hhs.texas.gov/services/disability/early-childhood-
intervention-services
Laboratory
e Department of State Health Services (DSHS) Laboratory performs
testing for Texas Health Steps and NBS clients for the State of Texas. e
following provides contact information for ordering laboratory supplies,
inquiries on collection, submission and shipping of specimens, and
obtaining test results.
For Texas Health Steps
Requests for Texas Health Steps laboratory supplies should be made on
Form G399 and can be submitted to the DSHS Laboratory Container
Preparation Group by:
Email: ContainerPrepGroup@dshs.state.tx.us
Fax: 512-776-7672
Phone: 512-776-7661 or 888-963-7111, Ext 7661
• Specimen shipping questions, call 512-776-7569 or
888-963-7111, Ext 7569
• Specimen collection and submission questions, call
512-776-6236 or 888-963-7111, Ext 6236
• Test result inquiries, call 512-776-7578 or Fax 512-776-7533
• Online Results: Access Texas Health Steps test results online using the
Results - Web Portal web application for Clinical Chemistry. To gain
access, download, complete, and submit the required access forms.
ey are available at dshs.texas.gov/lab/remotedata.shtm
• For gonorrhea and chlamydia adolescent screening supplies, specimen
collection and submission questions, call the DSHS Laboratory
Customer Service, 512-776-6030 or 888-963-7111, Ext 6030 or go to
dshs.texas.gov/lab/micCBintro.shtm
• For HIV screening supplies, specimen collection and submission
questions, call the DSHS Laboratory Customer Service, 512-776-6030
or 888-963-7111, Ext 6030 or go to dshs.texas.gov/lab/sero_about.
shtm
For NBS
A written request for Newborn Screening (NBS) specimen collection form
(NBS3) is required. To obtain an order form for written requests, call the
Container Preparation Group at 512-776-7661 or
888-963-7111, Ext 766.
• Specimen submission and testing questions, call 512-776-7333 or 888-
963-7111, Ext 7333
• Test result inquiries, call 512-776-7578 or Fax 512-776-7533
• Online Results: Access Newborn Screening (NBS) test results online
using the Texas NBS Web Application. To gain access, download,
complete, and submit the required access forms. ey are available at
dshs.texas.gov/lab/remotedata.shtm
Childhood Lead Poisoning Prevention Program
800-588-1248 | dshs.texas.gov/lead/default.shtm
To Report Potential Medicaid Fraud
HHSC Client or Provider Fraud Investigations:
800-436-6184 | oig.hhs.texas.gov
Medical Transportation Program (MTP)
877-633-8747
hhs.texas.gov/services/health/medicaid-chip/programs-services/
medical-transportation-program
Texas Medicaid & Healthcare Partnership (TMHP)
General Inquiries Line: 800-925-9126 | tmhp.com
Texas Health Steps Quick Reference Guide - revised 07/01/2024 2
