Date: June 12, 2026
Attention: All Providers
Call to action: Texas Children’s Health Plan (TCHP) would like to provide clarification regarding Sports Physicals (CPT 97169).
TCHP is currently aware of a claims processing issue that may be impacting the adjudication of sports physicals, resulting in denials with the following code:
PPMBD–Service Denied Because The Related Or Qualifying Service Was Not Paid Or Identified
Please note: Sports physicals remain a covered benefit from our Healthy Rewards Program/Value-Added Services (VAS) Program. Texas Children’s Health Plan CHIP, STAR and STAR Kids members ages 5 to 19 years can receive a no-cost sports and school physical. A Texas Health Steps or well-child visit within the last 12 months is required. Please see more details on the Healthy Rewards Program here.
What You Need to Know
- Sports physicals (CPT 97169) continue to be a covered Healthy Rewards/VAS benefit for eligible members
- TCHP is actively working to resolve the current claims processing issue
- Additional guidance will be provided once the issue has been addressed
Next Steps
- Providers may continue to submit claims for covered services
- At this time, no additional action is required; further instructions (including any necessary next steps for impacted claims) will be shared once the issue is resolved
We apologize for any inconvenience this may cause and appreciate your patience as we work toward a resolution.
*Restrictions and limitations may apply and may vary by plan, including but not limited to age, gender and covered benefits by program. Extra benefits valid during the eligible state fiscal year (September 1, 2025 to August 31, 2026). Must be an active Texas Children's Health Plan member at time of verification to receive extra benefit. Unless otherwise stated, reward must be redeemed in the current eligible year. Purchase of alcohol, tobacco, illegal drugs, or firearms is prohibited with the reward cards. Unless otherwise stated, rewards are limited to one member per eligible year. TCHP is not responsible for lost or stolen rewards. Depending on the benefit, the reward can be requested up to 60 days after the end of the eligible year. Allow up to 90 days for delivery of the reward.
If you have any questions, please email Provider Relations at providerrelations@texaschildrens.org.
For access to all provider alerts: www.texaschildrenshealthplan.org/provideralerts.
