Additional development screenings and autism screenings now allowable and payable beyond the standard screenings
Effective Date: June 3, 2020
Attention: Primary Care ProvidersCall to action: In addition to the required screenings, TCHP is allowing for a total of 12 developmental screenings up to age 6 during a Texas Health Steps Checkup within the following ages:
8.1- 2 screenings
At ages 0-11 months
8.2- 3 screenings
At age 12-23 months
8.3- 2 screenings
At ages 12-23 months
8.4- 2 screenings
At ages 24-35 months
8.5- 1 screening
At 3 years of age
8.6- 1 screening
At 5 years of age
8.7-1 screening
At 6 years of age
If a developmental or autism screening that is required in the Required Screening Ages and Recommended Tools table is not completed during a previous checkup or if the member is being seen for the first time, standardized developmental screening tool (ASQ or PEDS) must be completed through 6 years of age (procedure code 96110/96110 U6-for autism screening). As a reminder, Texas Health Steps requires the following standardized developmental screening tools at these ages:
Required Screening Ages and Recommended Tools
Screening Ages
Developmental Screening Tools
Autism Screening Tools
9 months
Ages and Stages Questionnaire (ASQ) or Parents’ Evaluation of Development Status (PEDS)
N/A
18 months
ASQ or PEDS
Modified Checklist for Autism in Toddlers (M-CHAT) or M-CHAT Revised with Follow-Up (M-CHAT R/F)
24 months
ASQ or PEDS
M-CHAT or M-CHAT R/F
3 years
ASQ, Ages and Stages Questionnaire: Social-Emotional (ASQ:SE) or PEDS
N/A
4 years
ASQ, ASQ:SE or PEDS
N/A
How this impacts providers: Providers should review and understand the complete Developmental screening guidelines available here: (update link when new guideline document is approved).
Developmental screening is limited to once per rolling calendar year by any provider, outside of a Texas Health Steps medical checkup when medically necessary.
This screening should only be competed for a diagnosis of suspected developmental delay or to evaluate a change in developmental status outside of a Texas health Steps medical group.
If a provider administers a standardized and validated developmental screening at additional checkups other than those listed in the Required Screening Ages and Recommended Tools table, the rationale for the additional screening, which may be due to provider or parental concerns should be documented.
Autism screening is required at 18 months of age and again at 24 months of age.
If not completed at 24 months of age it should be completed at 30 months of age.
A third screening may be performed as a follow-up to a previous abnormal screening by 30 months of age.
A TCHP Medical Director / Physician Reviewer will review requests for developmental screening outside of these limits on an individual basis.
Texas Health Steps Medical Checkup Periodicity Schedule for Infants, Children, and Adolescents: Click Here.Next steps for providers: Providers should ensure their understanding of the guidelines and coordinate with their staff.
If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.For access to all provider alerts,log into: www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers
