Key Reminders: Texas Health Steps (THSteps) Quick Reference Guide
As a reminder, please use the appropriate codes when billing for THSteps checkups. Below are several codes we’d like to highlight. You can also reference the THSteps Quick Reference Guide for more details.
Benefit Code EP1 should be billed for THSteps claims only
|Texas Health Steps Medical Checkup Billing Codes|
|Use Provider Identifier – Benefit Code EP1|
ICD 10 CM Diagnosis Z23 must be use when Immunization administered
|Use code Z23 to indicate when immunizations are administered.|
Modifiers which must be included to get receive reimbursement
|FQHC and RHC
Federally qualified health center (FQHC) providers must use modifier EP for Texas Health Steps medical checkups. Rural health clinics (RHC) providers must bill place of service 72 for Texas Health Steps medical checkups.
Procedure codes and Diagnosis which must be included to receive reimbursement:
|Texas Health Steps Medical Checkups|
|*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, 9 through 28 days|
|Z00129||Routine child exam|
|Z00121||Routine child exam, abnormal|
|Z0000||General adult exam|
|Z0001||General adult exam, abnormal|
For questions or additional information, please contact our BCBSTX Medicaid Provider Service Center at 1-877-560-8055 or your Texas Medicaid Network team at 1-855-212-1615 or via email Texas Medicaid Network Department.
The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.