January 2017

Texas Health Steps: Mental Health Screening Procedure Code 99420 Discontinued

Effective for dates of service on or after Jan. 1, 2017, procedure code 99420 was discontinued by Centers for Medicare & Medicaid Services (CMS) in accordance with the 2017 annual Healthcare Common Procedure Coding System (HCPCS) update. Procedure code 99420 will be replaced by two new procedure codes: 96160 and 96161.

Mental health screenings for behavioral, social and emotional development is required at each Texas Health Steps (THSteps) checkup. Mental health screenings using one of the validated, standardized mental health screenings tools recognized by THSteps is required once for all clients who are 12 through 18 years of age.

Procedure Codes 96160 and 96161
A mental health screening must be submitted with procedure code 96160 for a screening tool completed by the adolescent, or procedure code 96161 for a screening tool completed by the parent or caregiver on behalf of the adolescent. When claims with either of these procedure codes are submitted for mental health screenings, one of the validated, standardized mental health screening tools recognized by THSteps must be used.

• Only one procedure code – 96160 or 96161 – will be reimbursed for the mental health screening per client per lifetime based on the description of the procedure code and the service rendered.
• Procedure codes 96160 and 96161 will not be reimbursed for the same client for any date of service.
• Procedure code 96160 or 96161 must be submitted with the same date of service by the same provider as procedure code 99384, 99385, 99394, or 99395.

The client’s medical record must include documentation identifying the tool that was used, the screening results and any referrals that are made.

Providers can refer to the Texas Medicaid Provider Procedures Manual Children’s Services Handbook, subsection 5.3.11.1, “Comprehensive Health and Developmental History,” for additional information.