Revised: September 16, 2022 Show
OverviewChild and Teen Checkups (C&TC) is the name for Minnesota’s Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program, a required service under Title XIX of the Social Security Act. C&TC is a comprehensive child health program provided to children and teens (newborn through the age of 20 years) enrolled in Medical Assistance (MA) or MinnesotaCare. The purpose of the program is to reduce the impact of childhood health problems by identifying, diagnosing and treating health problems early, and to encourage the development of good health habits. Child and Teen Checkups are based on the recommendations of the American Academy of Pediatrics (AAP) and the United States Preventive Services Task Force (USPSTF). MHCP regularly updates the C&TC Schedule of Age-Related Screening Standards (Periodicity Schedule) (DHS-3379) (PDF) according to federal requirements of the EPSDT program, state legislation and the unique needs and epidemiology of Minnesota's C&TC-eligible population. Minnesota is required to provide an annual report to Centers for Medicare & Medicaid (CMS) that includes our state’s participation rate based on eligible children receiving a C&TC screening service during the reporting year. Therefore, accurate billing and coding is critical in documenting the screenings that have been provided. States are also required to follow up on referrals made from results of an EPSDT screening to assure that children and families receive the necessary services to correct or improve health problems. It is important that providers report all referrals for complete C&TC health visit claims using one of the four HIPAA required referral codes. DHS provides these referral codes through a secure data system. C&TC program staff provide outreach communications and assistance to families of children younger than age 11 requiring further evaluation, diagnosis and treatment for a condition identified during the C&TC screening visit. Refer to the HIPAA Compliant C&TC Referral Codes Fact Sheet for more information. Coordination of Preventive Health CareThe C&TC program emphasizes the need to avoid fragmentation of care and the importance of continuity of care in comprehensive health supervision. Providers can help reduce duplication of services by substituting a C&TC screening service (when appropriate) for other preventive health care visits, such as: Eligible ProvidersTo be reimbursed for C&TC screening services, fee-for-service C&TC screening providers must be enrolled as either of the following and have a signed C&TC Provider Agreement Addendum: Individual Treating ProvidersEligible treating providers include the following: Non-enrolled public health nurses approved by the Minnesota Department of Health (MDH) may provide services after completing the two- to three-day C&TC screening component training. Staff eligible to provide some components under supervision of a physician or dentist includes the following: Facility TypesEligible facility types include the following: Some providers listed can complete only certain components that are within their scope of practice as a licensed professional. Refer to the Enrollment with MHCP section of the MHCP Provider Manual for more information about enrolling as an MHCP provider. Eligible MembersChildren and teens, newborn through the age of 20 years, enrolled in Medical Assistance (MA) or MinnesotaCare are eligible for C&TC services. Children enrolled in MA or MinnesotaCare through a managed care organization (MCO) must receive screening services from their Prepaid Minnesota Healthcare Program provider. Use MN–ITS Interactive Eligibility Request to verify a member’s eligibility for this service. Covered Services – Medical screeningsRefer to the C&TC Schedule of Age-Related Screening Standards (Periodicity Schedule) (DHS-3379) (PDF) for Minnesota’s age-related screening standards schedule details. Foster care Health Education and Anticipatory GuidanceHealth education is a required component of screening services and includes anticipatory guidance. Health education and counseling to either parents or guardians and children is required. Reimbursement for health education and anticipatory guidance is included in the payment of the Evaluation and Management (E&M) code for a C&TC screening. For more information on health education and anticipatory guidance, refer to the Child and Teen Checkups Fact Sheets for anticipatory guidance, 0–10 years and 11–20 years. Preventive counseling is included in the preventive medicine E&M service; do not bill for preventive counseling separately. Bill with CPT codes 99401–99404 if patient visit is for counseling only. Health HistoryHealth history needs to include social determinants of health. For more information about social determinants of health, refer to the Health History and Social Determinants of Health Fact Sheet. Developmental and Social-Emotional or Mental Health ScreeningsDevelopmental and social-emotional or mental health screenings are a C&TC screening component. A MN Developmental Screening Task Force recommended screening instrument is preferred, however, a DHS-accepted screening instrument can be used. Also, review Screening for Autism Spectrum Disorder (ASD) information in this manual section. Refer to the Developmental, Social-Emotional, and Autism Spectrum Disorder Screening in Early Childhood or Mental Health Screening, 6-20 Years fact sheets developed by MDH and DHS and the DHS Children’s Mental Health Division Screening webpages for more information on developmental and social-emotional or mental health screening and recommended instruments. Currently, no recommended standardized instrument adequately covers both developmental and social-emotional domains. Two separate screening instruments are needed to adequately screen for potential developmental and social-emotional concerns. Based on the recommendation by the AAP, The Survey of Well-Being of Young Children (SWYC) may be used only for developmental screening only when performing a complete C&TC exam in a clinic setting. Use of the SWYC is not recommended in the C&TC setting for social-emotional (SWYC Pediatric Symptom Checklist) or autism screening. Refer to the C&TC Developmental and Social - Emotional Screening Recommendations - Minnesota Department of Health webpage. This webpage has links to two important documents: Instruments at a glance for C&TC Clinic Settings and Instructions for Administering The Survey of Well-Being of Young Children screening in the C&TC Clinic Setting. For settings outside of a medical clinic, refer to the Recommended Screening Instruments from the Minnesota Interagency Developmental Screening Task Force section of the Minnesota Department of Health (MDH) website. The Minnesota Developmental Screening Task Force does not recommend the use of The SWYC in screening programs. Providers engaging in screening must meet the instrument-specific criteria, as outlined by the publisher. Providers using the standardized instruments may include physicians, nurse practitioners, physician assistants, nurses, medical assistants or other appropriately trained staff. Maintain required documentation in the child’s health record. Documentation must include, at a minimum, the name of the screening instruments used, the scores, and the anticipatory guidance provided to the parent or caregiver related to the screening results. If the screening results are abnormal, documentation must include how this is being addressed, such as referral to the local school district (directly or via Help Me Grow), appropriate medical specialists, follow-up plan of care and, when appropriate, a referral to a local community service agency. For more information, see the Referral section of the Developmental, Social-Emotional, and Autism spectrum Disorder Screening in Early Childhood or the Mental Health Screening (6-20 Years) Fact Sheets on the MDH website. Bill developmental and social-emotional or mental health screenings on the same claim as other C&TC services. Use the following CPT codes: You may bill for both a developmental and a social-emotional or mental health screening on the same date of service on the same claim. However, you may not bill for more than two developmental screenings and more than two social-emotional and mental health screenings on the same date of service. When a developmental and social-emotional or mental health screening is provided at other pediatric visits, bill the developmental and social-emotional or mental health screening on the same claim as the other pediatric services. Screening for Autism Spectrum Disorder (ASD) in ToddlersProvide ASD-specific screening only after using an approved developmental and social-emotional screening instrument during the last year. The American Academy of Pediatrics (AAP) and the C&TC Schedule of Age-Related Screening Standards (Periodicity Schedule) (DHS-3379) (PDF) suggests that autism screenings should be part of standard 18- and 24-month well-child checks. When billing for an ASD-specific screening, use a standardized screening instrument according to the guidelines of the developer such as the Modified Checklist for Autism in Toddlers Revised, with Follow-up (M-CHAT-R/F). Bill an ASD-specific screening on the same claim as other C&TC services using CPT code 96110 and modifier U1. When an ASD-specific screening is completed in addition to another developmental screening using two separate standardized screening instruments, bill for the ASD-specific screening and the developmental screening on the C&TC claim using one of the following: Maintain required documentation in the child’s health record. At a minimum, documentation must include the name of the screening instrument(s) used, the score(s) and the anticipatory guidance provided to the parent or caregiver related to the results. If the screening results are atypical, documentation must include a follow-up plan of care including to whom you referred the child and family and any other ways that the atypical screening results are being addressed. It is important to make a referral right away, no need to wait. Referrals The following are examples of providers or resources to refer children to when they need additional evaluation: You may also offer families screening resources and provide information on expected milestones from either the Help Me Grow or Learn the Signs Act Early websites. Another resource with Minnesota-specific screening, identification and referral information is the First Steps: Pathway to learning, playing and growing (PDF), which provides a summary of key developmental milestones that infants and toddlers should be achieving. This resource contains tips, tools and guidance to help aid a child’s development. It also explains resources available to parents and caregivers who have questions or concerns about their child’s development. The PDF is available in Hmong, Karen, Oromo, Russian, Somali, Spanish and Vietnamese. Refer to the Next Steps: Pathway to services and supports for a child recently identified with ASD (PDF) for children with ASD and related conditions. This PDF helps parents and caregivers understand options for their child in the year after diagnosis. This resource is also available in Hmong, Karen, Oromo, Russian, Somali, Spanish and Vietnamese. Refer directly for a comprehensive evaluation or early intervention services using the Pathway to EIDBI Services referral tool. Anyone can make a referral, including the family. Visit the Minnesota Autism Resource Portal for more information about ASD. Postpartum Depression ScreeningPostpartum depression screening is covered as a C&TC service or at other pediatric visits. Suggested screening times are at the 0 to 1-month visit, the 2-month visit, and either the 4-month or 6-month visit; however, providers may do screening any time up to 13 months. Use one of the following standardized screening instruments: Providers that meet the instrument-specific criteria for administering the screening tool as outlined by the publisher may perform maternal depression screenings. Depending on the tool, this may include physicians, nurse practitioners, physician assistants, nurses, medical assistants or other appropriately trained staff. MHCP allows up to six postpartum depression screenings for any accompanying caregiver at the C&TC visit for each child who is less than 13 months old. For documenting postpartum depression screening services, record the name of the completed screening instrument and document that it was performed as a “risk assessment” in the child’s medical record. You are not required to include the screening score results or a copy of the screening instrument in the child’s record. You may give the caregiver a paper copy of the screening instrument to bring to a referral appointment or destroy it if it is not wanted. Refer to MDH’s Postpartum Depression - Information for Health Professionals webpage and the Postpartum Depression Screening FACT Sheet for more information on postpartum depression screening, referral and documentation. You may find helpful tools located on the Depression or Anxiety During and After Pregnancy Brochure and Postpartum Wellbeing Plan webpage. Refer to the DHS Children’s Mental Health Screening webpage for information on the relationship between postpartum depression and children’s developmental, social-emotional and mental health. Bill for the postpartum depression screening only when using one of the standardized screening instruments. When billing for a postpartum depression screening, refer to the following criteria: The NCCI procedure-to-procedure (PTP) edit pairs immunization administration codes (90460, 90461, 90471-90474) with postpartum depression screening. You may receive the NCCI edit when submitting claims for postpartum depression screening with CPT code 96161. These edits have a Correct Coding Modifier Indicator of “1” and, therefore, will bypass the PTP edit if you correctly add a PTP-associated modifier. See Minnesota National Correct Coding Initiative (NCCI) page for information about modifiers. Tobacco, Alcohol or Drug Use Risk AssessmentRisk assessment for tobacco, alcohol and drug use is required for ages 11 through 20 years, followed by appropriate action. For more information, including recommended risk assessment or screening tools, refer to the Tobacco, Alcohol or Drug Use Risk Assessment Fact Sheet. Resources for adolescent health include the following: Reimbursement for this assessment using a standardized tool is included in the payment of the Evaluation and Management (E&M) code used for a C&TC screening visit. Immunization and VaccinationsReview the immunization status of a child, teen or young adult compared to the current Recommended Childhood and Adolescent Immunization Schedule from the Advisory Committee on Immunization Practices (ACIP). ACIP is part of the Centers for Disease Control and Prevention (CDC) and provides current recommendations for vaccine administration, schedules of periodicity, and appropriate dosage and contraindications. You may also use the Minnesota Department of Health (MDH) Childhood and Adult Recommended Immunization Schedules, which are revised annually and incorporate the ACIP schedule. State law requires all MHCP-enrolled providers who administer pediatric vaccines to enroll in the Minnesota Vaccines for Children (MnVFC) program. MDH administers the MnVFC for MHCP members ages 1 through 18 to provide most pediatric vaccines to participating providers at no cost.Providers must obtain vaccines through MnVFC whenever available. MHCP covers flu vaccines and other recommended vaccinations for adults aged 19 or older. When billing for immunizations or vaccinations administered during a C&TC screening, enter the correct immunization or vaccination codes with the SL modifier when applicable, and add the correct administration codes to the C&TC claim. Refer to the MHCP Provider Manual – Immunizations and Vaccinations section for details on coding and billing criteria. Vaccine CounselingEffective Jan. 1, 2022, stand-alone vaccine counseling visits are covered when provided to children and youth under age 21. Providers may counsel for COVID-19 vaccinations or standard pediatric vaccines. Counseling may be provided either in person or via telehealth. Providers billing for counseling services must be able to administer the vaccine for which they are counseling. Billable stand-alone vaccine counseling visits do not replace immunization review and administration as required during a complete C&TC visit. These visits are only billable when done outside of routine well visits. Review the Immunizations and Vaccinations webpage for further information. Stand-alone vaccine counseling visits codes
Immunization and vaccinations resources Laboratory Tests or Risk AssessmentFor information about billing for lab services, refer to the Laboratory/Pathology Services section of this manual. MHCP covers venipuncture and capillary specimen collection and handling. A Clinical Laboratory Improvement Amendments (CLIA) certified lab must perform and bill for most lab services. If a provider has a CLIA certified lab on site and lab services are provided on site, the CPT code for the lab service may be included in the C&TC visit claim. Payment for lab services is in addition to the C&TC bundled rate. If a provider refers patients off site to a CLIA certified lab for lab tests or screenings that are required or part of a C&TC health visit, the off-site lab bills for the lab tests, not the provider. That lab test will not be included on the C&TC health visit claim. If a required lab service was not done at a C&TC visit, do not include it on the C&TC visit claim. Include documentation in the medical record with the date and results of any required lab screening or test that the C&TC provider or another provider performed within the required age range. Document in the medical record if a required lab screening or test was not done during the required age range C&TC visit due to the child, adolescent or parent declining the test or being uncooperative. Attempt the screening or test again in the future. Blood lead test When billing a blood lead test, use the correct CPT code for the lead test. Refer to the following documents and websites for more blood lead resources: Hematocrit or hemoglobin For more information, including documentation of results and follow up, refer to the C&TC Hemoglobin or Hematocrit Fact Sheet. Hepatitis C For more information, refer to the C&TC Hepatitis C Virus (HCV) Screening Fact Sheet. Tuberculosis (TB) risk assessment TB testing is not mandatory but is a covered service if clinical documentation supports the medical need for the test. When performing TB testing during a C&TC screening, bill with the appropriate CPT code on the C&TC screening claim. For more information and recommendations, review the C&TC TB Screening Fact Sheet and the Pediatric TB Risk Assessment Tool. Sexually transmitted infection (STI) risk assessment and human immunodeficiency virus (HIV) screening lab test Beginning no later than 11 years of age, assess all youth for risk of sexually transmitted infections at each C&TC well visit. Universal HIV screening (offering HIV blood testing to all youth, regardless of risk factors) is required at least once between 15 and 18 years of age, as recommended by the American Academy of Pediatrics (AAP) and Centers for Disease Control and Prevention (CDC). Refer to the MDH Child and Teen Checkups Fact Sheet for Sexually Transmitted Infection (STI) Risk Assessment and Human Immunodeficiency Virus (HIV) Screening for more information, including appropriate documentation of confidential screening test results in medical records. Providers may screen for STIs without parental knowledge or consent. If the youth declines the HIV test or if his or her HIV status is already known, document the reason that the HIV blood test was not done. Youth who have risk factors for HIV exposure should be tested at least annually. (Minnesota Statutes 144.343) Resources for adolescent health include the following: Dyslipidemia risk assessment Vision screening Starting at age 11, vision screening must be done once during each of the age ranges as indicated on the Periodicity Schedule (DHS-3379) (PDF). Refer to the MDH Vision Screening website for detailed procedures and Equipment for visual acuity screening (PDF) for recommended wall charts and equipment. Instrument-based vision screening may be used as an alternative to wall charts for children 3-5 years old who are unable or unwilling to cooperate with routine vision screening. For more information, refer to the Vision Screening Fact Sheet. Bill instrument-based vision screening using CPT codes 99174 or 99177. An NCCI procedure-to-procedure (PTP) edit pairs preventive visit CPT codes in the range of 99381–99397 with vision screening. You may receive the NCCI edit when submitting claims for vision screening with CPT code 99173. These edits have a Correct Coding Modifier Indicator of “1” and, therefore, bypass the PTP edit if you correctly add a PTP-associated modifier. See Minnesota National Correct Coding Initiative (NCCI) page for information about modifiers. Hearing screening Oral health Fluoride varnish application (FVA): Obtain informed consent for this procedure, either verbally or in writing. Document that you obtained verbal consent, including discussion of benefits and risks of FVA, with each application. Alternatively, a written consent signed by the parent or guardian is valid for up to one year. For more information on FVA by primary care and other non-dental providers, refer to Fluoride varnish in the Child and Teen Checkups (C&TC) setting and the Oral Health Fact Sheet in the MDH C&TC webpages, and the National Maternal and Child Oral Health Resource Center. Use CPT code 99188: Primary care providers (physicians or other qualified health care professionals) and trained clinical staff. Refer to the Non-Dental Health Provider section under Dental Services for specific billing instructions or for more information. Covered Services – Dental Screening by a C&TC Medical ProviderThe C&TC dental screening components include the following: Refer to the Schedule of Age-Related Dental Standards (C&TC Dental Periodicity Schedule) (DHS-5544) (PDF) for Minnesota’s age-related dental standards schedule details. Refer to the American Academy of Pediatric Dentistry Guideline on Periodicity of Examination, Preventive Dental Services, Anticipatory Guidance/Counseling, and Oral Treatment for Infants, Children, and Adolescents (PDF) and the Dental Checkups Fact Sheet for more information. For details on dental benefit coverage policy, refer to the Dental Services section of this manual. Primary care providerrequirements include the following: Other Covered ServicesThe following services are also covered: Screening ExceptionsFor some situations, it is not possible or appropriate to require C&TC providers to complete certain components of the C&TC screening as outlined in the Schedule of Age-Related Screening Standards. According to the Administrative Uniformity Committee (AUC) recommendations, use the billing guidelines for the situations listed in the claim guideline exceptions table when you cannot perform screening components or an initial screening is not appropriate. If a screening component is refused by a parent or young adult, provide education of the risks and benefits of the refused component. Claims submitted using the following guidelines for an exception identified in the table will be recognized as completed C&TC claims. When submitting a claim, follow these requirements: Claim guideline exceptions
Noncovered ServicesMHCP does not cover the following services under C&TC: AuthorizationC&TC screening services and screening components do not require authorization. For diagnosis and treatment services that may require authorization, refer to the MHCP Provider Manual - Authorization Section. For clinic or physician services provided to a child not included in the C&TC screening benefit, refer to the MHCP Provider Manual – Physician Services section. BillingUse the 837P claim to bill for C&TC services. Refer to the MN–ITS User Guide for Child and Teen Checkups when submitting claims via MN–ITS Interactive. If billing X12 Batch, follow HIPAA electronic data interchange (EDI) as outlined in the X12 implementation guides and follow the standards as outlined in the Minnesota Uniform Companion Guides. C&TC billing processes include complying with HIPAA, AUC and MHCP system and data requirements. Billing C&TC screening services accurately is necessary to do the following: Follow the Schedule of Age-Related Screening Standards (Periodicity Schedule) (DHS-3379) (PDF) to identify required C&TC screening components for the periodic visit, including a referral to a dentist. Enter the appropriate CPT or HCPCS codes for each age-related component provided in MN–ITS-837P claim form. On claims for C&TC screening services, include the following: Refer to the Schedule of Age-Related Dental Standards (Dental Periodicity Schedule) (DHS-5544) (PDF) for dental screening components. For policy and billing dental screening components, refer to the Dental Services section of this manual. Separate E&M ServiceIf a significant, separately identifiable E&M service is provided at the time of the C&TC screening, bill that E&M code with the modifier 25 on a separate claim from the C&TC. Send in electronic attachment supporting key components of the billed E&M. Also, documentation in the member’s health record must support key components of the billed E&M services and show that it is not an extended C&TC visit. Follow CPT instructions for appropriate coding. ReferralsA referral for C&TC reporting purposes indicates that the child needs to be seen again for further assessment, diagnosis or treatment of a problem, or a concern that was identified during the C&TC screening. Include the appropriate referral code on the C&TC claim. The referral can be made to the screening provider or to another provider, and can be provided on the same day as the C&TC visit. Bill the referral services visit on a different claim than the C&TC even if the visit occurs on the same day as the C&TC screening. HIPAA-Compliant Referral Condition CodesC&TC HIPAA-compliant referral condition codes (also called referral codes) indicate a referral was made as result of the C&TC screening. C&TC claims must list the most appropriate HIPAA-compliant referral condition code: ST, S2, AV or NU. MHCP C&TC screening payment requires one of the four HIPAA-compliant referral condition codes to be entered at the claim (header) level. DHS provides referral codes through a secure data system to C&TC programs throughout Minnesota (local public health and tribal health) under contract with DHS. C&TC program staff provide outreach communications and assistance to families of children younger than age 11 requiring further evaluation, diagnosis and treatment for a condition identified during the C&TC screening visit. Refer to the HIPAA Compliant C&TC Referral Codes Fact Sheet for more information. Two-Character HIPAA-Compliant Referral Condition Codes and DefinitionsUse the most appropriate referral code from the table below:
HCPCS Code S0302MHCP does not require the use of HCPCS code S0302 and considers this code as informational only. If a submitted charge is entered on the same line as the HCPCS Code S0302, MHCP will deduct that amount from the total charges on the claim. If the HCPCS code S0302 is reported without a HIPAA-compliant referral condition code on that claim, the claim will deny. DHS will recognize a claim as a C&TC screening only when a HIPAA-compliant referral condition code is entered on the claim. ResourcesDepartment of Human Services (DHS) C&TC resources Minnesota Department of Health (MDH) C&TC resources Other C&TC resources TrainingTraining and e-learning modules Fluoride varnish online trainings Note: this training was filmed before the COVID 19 pandemic. Please follow the AAP infection control recommendations. Note: Although not demonstrated in these videos, appropriate personal protection equipment including eye shields must be worn during fluoride varnish application. Legal ReferencesMinnesota Statutes, 144.343 (minor
consent) Code of Federal Regulations, title 42, section 441.50-441.62 (Early and Periodic Screening, Diagnosis, and Treatment of Individuals Under Age 21) Which strategies does the nurse keep in mind when communicating with a hearing impaired patient?Speak clearly, slowly, distinctly, but naturally, without shouting or exaggerating mouth movements. Shouting distorts the sound of speech and may make speech reading more difficult. Say the person's name before beginning a conversation.
What is the best intervention you should use when communicating with a hearing impaired adult quizlet?To facilitate communication with a hearing-impaired person, face the patient when speaking, speak slower and in a normal tone, talk toward the patient's best or normal ear, articulate clearly, and demonstrate ideas you wish to convey. You should also position yourself so the light is on your face when you speak.
When communicating with a patient who has expressive aphasia which strategy is priority for the nurse quizlet?When communicating with a patient who has expressive aphasia, the highest priority for the nurse is: 1 To ask open-ended questions. 2 To understand that the patient will be uncooperative.
Which medicine may cause irritation of the optic nerve?Topiramate can cause acute glaucoma (an eye condition that damages the optic nerve). People often experience eye pain, headache, and blurred vision.
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A patient with a history of a hearing deficit comes to the medical clinic for a routine checkup
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