Texas Health and Human Services / Texas Health Steps

Texas Health Steps and Medical Telecommunication

Texas Health Steps provides preventive health-care services for children and adolescents ages birth through 20 years. Regular preventive medical checkups provided through Texas Health Steps usually are not eligible for remote delivery through telemedicine. However, during a declared state of disaster by the Texas governor—such as the COVID-19 pandemic and other health emergencies—the Texas Health and Human Services Commission (HHSC) may allow some of these services to be performed remotely.

During the COVID-19 declared disaster, HHSC is allowing remote delivery of certain components of Texas Health Steps preventive medical checkups for children ages 25 months and older. But some of the checkup requirements, such as immunizations and physical exams, still require an in-person visit. As a result, health-care providers must follow up with their patients to ensure completion of any outstanding checkup components within 6 months of the telemedicine checkup.

Medical records must be maintained for all telemedicine services. Documentation for a service provided via telemedicine must be the same as for a comparable in-person service.

The Texas Health Steps Periodicity Schedule specifies when each checkup component is due for each age-appropriate preventive medical checkup. The checkup components are based on AAP guidance as well as state requirements and federal guidelines.

Texas Health Steps requires that all federal- and state-mandated checkup components be documented in the medical record for the checkup to be considered complete and to qualify for provider reimbursement. Any checkup component not completed must be noted in the medical record, along with the reason it was not completed and a plan to complete it. The medical record must also contain documentation of all screening tools used, screening results and referrals to other health-care providers. Texas Health Steps child health clinical record forms are optional but recommended to assist providers with documentation of all required checkup components.

When Texas Health Steps preventive medical checkups are allowed by medical telecommunications:

  • Health-care providers may perform the checkups via telecommunication using their Texas Health Steps provider identifier and benefit code EP1.
  • Telemedicine and telehealth services must be billed with modifier 95.
  • Providers should use the traditional billing code for a face-to-face checkup along with the modifier 95 to show the exam was conducted via medical telecommunications.
  • Procedure codes that indicate remote services (telemedicine or telehealth) in the description do not need the modifier 95.
  • Telephone or audio-only medical care provided must be billed with modifier 93.

Medical conditions and health issues identified during Texas Health Steps preventive medical checkups may be addressed by a specialist or subspecialist through telecommunication services. The majority of medical telecommunication encounters for patients enrolled in Texas Health Steps are for behavioral health needs such as attention-deficit/hyperactivity disorder (ADHD) and involve a real-time audiovisual session. However, many medical conditions, such as dermatology conditions, also can be treated remotely.

According to the American Academy of Pediatrics (AAP) 2022 technical report “Telehealth: Opportunity to Improve Access, Quality, and Cost in Pediatric Care”:

Certain conditions that do not require such hands-on contact, such as attention-deficit/hyperactivity disorder and other behavioral and mental health diagnoses, including medication management, are ideally suited to telehealth management, with provisions for in-person monitoring of growth and laboratory studies. For adolescents, telehealth can be used for contraceptive and reproductive health counseling, with assurance that, for sensitive topics, the clinician can create an environment in which adolescents can freely answer in confidence.

Adult consent and supervision during a Texas Health Steps preventive medical checkup via medical telecommunication

Remember, before providing telemedicine services, the provider must obtain written or verbal informed consent for treatment from the patient or patient’s parent or guardian. That consent must be documented in the patient’s medical record.

In addition, a responsible adult should be present with a child or adolescent during any medical telecommunication appointment.

Except in situations in which adolescent can legally consent to their own care, a responsible adult such as a parent, legal guardian, school nurse, pediatrician or other health-care provider should always be with a youth during the telehealth service, according to the AAP.

Beginning at about age 11, adolescents can and should have some private time with the health-care provider during their Texas Health Steps preventive medical checkups so they will feel comfortable sharing information and participating in their own health care. Providers should let parents or guardians know that an adolescent will need time alone to speak privately with the provider during part of the checkup. Ask the adult to step away for a few minutes at that time.

The AAP suggests a provider explain that “just like we spend time in private when you come into the office, I would like us to spend part of this telehealth visit speaking privately as well. Do you think that’s something we can do today?”

For more information about specific COVID-19 flexibilities for Texas Medicaid and the Children’s Health Insurance Program (CHIP), visit HHSC’s Medicaid and CHIP provider information website. Texas Health Steps providers can scroll down to the tab for Texas Health Steps Checkups.







Main Menu