Coverage of Synagis (palivizumab) will end April 14 for people enrolled in Medicaid (both traditional and managed care) and the Children with Special Health Care Needs services program. Pharmacy claims and prior authorization requests will not be accepted or reviewed after that date.
Improving transition from pediatric to adult health care is a national priority, medical home standard, and meaningful use requirement for electronic health records. A new from Got Transition and the American Academy of Pediatrics (AAP) supports delivery of recommended health-care transition services in pediatric and adult primary and specialty care settings.
The tip sheet includes:
• An updated list of transition-related CPT codes.
• Clinical vignettes with recommended CPT and ICD-10 codes.
• Detailed CPT coding descriptions for transition-related services with selected coding tips.
The Texas Department of State Health Services Office of Title V Maternal and Child Health is soliciting feedback from primary care and specialty care physicians about their experiences with transition and medical home services. Information gathered will be used to improve support services for providers who care for children and youth with special health-care needs and their families.
The survey is brief, and responses are anonymous. You can access the survey here. Your participation is appreciated.
Effective February 1, 2017, the Pediatric Symptom Checklist-17 (PSC-17) may be used for adolescent mental health screening conducted during a Texas Health Steps checkup.
Screening for behavioral, social, and emotional development is required at each THSteps checkup. An additional mental health screen is required once for patients between the ages of 12 and 18. The approved screening tools are listed below:
- Pediatric Symptom Checklist (PSC-35)
- Pediatric Symptom Checklist-17 (PSC-17)
- Pediatric Symptom Checklist for Youth (Y-PSC)
- Patient Health Questionnaire (PHQ-9)
- Car, Relax, Alone, Forget, Family, and Trouble Checklist (CRAFFT)
The approved tools can be downloaded and used at no cost to the provider.
Procedure code 99420, which is used during a THSteps checkup to administer and interpret a mental health screening tool in adolescents, is being discontinued by the 2017 HCPCS code updates. Effective January 1, 2017, THSteps providers should use procedure code 96160 or 96161 for mental health screenings in adolescents 12 through 18 years of age.
A mental health screening must be submitted with procedure code 96160 for a screening tool completed by the adolescent, or procedure code 96161 for a screening tool completed by the parent or caregiver on behalf of the adolescent. When claims with procedure code 96160 or 96161 are submitted for mental health screenings, one of the validated, standardized mental health screening tools recognized by THSteps must be used.
Only one procedure code (96160 or 96161) may be reimbursed for the mental health screening per client per lifetime based on the description of the procedure code and the service rendered. Procedure codes 96160 and 96161 will not be reimbursed for the same client for any date of service. Procedure code 96160 or 96161 must be submitted with the same date of service by the same provider as procedure code 99384, 99385, 99394, or 99395.
More information on THSteps checkups and preventive medical checkup diagnosis codes is available on the THSteps website.