Texas Health Steps (THSteps): Complete Guide for Medicaid Providers in Texas
Texas Health Steps (THSteps) is a critical Medicaid benefit program designed to ensure children and young adults in Texas receive comprehensive preventive and medical care. As Texas’ version of the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program, Texas Health Steps focuses on early detection, timely treatment, and long-term health outcomes.
For healthcare providers, understanding Texas Health Steps billing, documentation, and compliance is essential to avoid claim denials and ensure proper reimbursement.
What Is Texas Health Steps?
Texas Health Steps is a Medicaid preventive healthcare program that covers medical, dental, vision, hearing, and behavioral health services for eligible children and young adults from birth through age 20.
The program ensures:
- Regular well-child checkups
- Preventive screenings
- Medically necessary diagnostic and treatment services
- Follow-up care and referrals
Texas Health Steps Eligibility
A child or young adult is eligible for Texas Health Steps if they:
- Are enrolled in Texas Medicaid
- Are between 0–20 years old
- Are in foster care or Medicaid managed care (automatically enrolled)
No separate enrollment is required once Medicaid eligibility is approved.
Services Covered Under Texas Health Steps
Medical Services
- Comprehensive well-child visits
- Physical exams and developmental screenings
- Laboratory and diagnostic testing
Immunizations
- Vaccinations per CDC and Texas schedules
- Preventive protection against childhood diseases
Dental Services
- Dental checkups starting at 6 months
- Cleanings, sealants, fillings, and restorative care
Vision & Hearing
- Routine screenings
- Diagnostic exams
- Medically necessary treatment
Mental & Behavioral Health
- Emotional and behavioral assessments
- Therapy and counseling when required
Case Management
- Care coordination
- Specialist referrals
- Follow-up on identified conditions
Why Texas Health Steps Is Important for Providers
For providers, Texas Health Steps is both a patient care program and a compliance-driven Medicaid service.
Proper participation helps:
- Improve preventive care outcomes
- Meet Medicaid and EPSDT requirements
- Reduce claim denials and audits
- Ensure timely Medicaid reimbursement
Incorrect billing or missing documentation can result in payment delays, recoupments, or denials.
Texas Health Steps Billing & Compliance Challenges
Common challenges include:
- Incorrect THSteps billing codes and modifiers
- Missing checkup components
- Incomplete documentation
- Failure to follow periodicity schedules
- Medicaid eligibility verification errors
These issues often lead to denied or underpaid claims, impacting practice revenue.
How Clinical RCM Solutions Helps Texas Health Steps Providers
At Clinical RCM Solutions, we specialize in Texas Medicaid and Texas Health Steps billing. Our services include:
✔ Accurate THSteps coding and claim submission
✔ Medicaid eligibility and benefits verification
✔ Documentation audits and compliance support
✔ Denial management and appeals
✔ HIPAA-compliant revenue cycle management
We help pediatric clinics, family practices, and multi-specialty providers stay compliant while maximizing reimbursement.
Frequently Asked Questions (FAQs)
What does Texas Health Steps cover?
Texas Health Steps covers preventive, diagnostic, and treatment services including medical, dental, vision, hearing, and behavioral health care for Medicaid-eligible children and young adults.
Is Texas Health Steps the same as EPSDT?
Yes. Texas Health Steps is Texas’ Medicaid EPSDT program.
Do providers need special enrollment for Texas Health Steps?
Providers must be enrolled with Texas Medicaid and follow Texas Health Steps billing and documentation guidelines.
Why are Texas Health Steps claims denied?
Common reasons include incorrect coding, missing components of the checkup, eligibility issues, and incomplete documentation.
Final Thoughts
Texas Health Steps plays a vital role in improving child and adolescent healthcare across Texas. For providers, proper understanding of THSteps billing and compliance is essential to ensure uninterrupted care and financial stability.
With the right RCM partner, managing Texas Health Steps doesn’t have to be complicated.
Call to Action
Need help with Texas Health Steps billing or Medicaid compliance?
📞 Call: +1 (713) 364-2644
📧 Email: clinicalrcm@gmail.com
🌐 Visit: https://clinicalrcm.com
Clinical RCM Solutions – Your Trusted Partner in Medicaid & Texas Health Steps Billing
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