Beginning Jan. 1, 2022, the cost of each kit in the Texas Department of State Health Services (DSHS) Texas Newborn Screening Program will go up slightly to accommodate the inclusion of spinal muscular atrophy screening, a leading genetic cause of death in infants and toddlers.
The cost will increase from $60.58 to $63.55. The DSHS laboratory now screens the samples for 55 conditions. DSHS will bill health care professionals who order test kits for those patients who are covered by insurance or who are deemed “self-pay.” (There is no charge for test kits used for children eligible for Medicaid or the Children’s Health Insurance Program.) The price hike will cover additional costs for laboratory and follow-up services.
The Healthcare Common Procedure Coding System (HCPCS) code for billing the newborn screening kit is S3620. To ensure payment for the costs of newborn screening test kits, physicians and practice managers should:
- Contact each health plan or insurance company to update existing contracts;
- Verify that HCPCS S3620 will be updated by Jan. 1 to match the new cost for the screening kit; and
- Submit newborn screening claims using HCPCS code S3620.
For frequently asked questions about the newborn screening program, refer to the state lab’s FAQs on specimen collection and billing.
TMA members who experience billing and coding problems can submit complaints to the TMA Reimbursement Review and Resolution Service (formerly known as the Hassle Factor Log program) or contact the TMA Knowledge Center at (800) 880-7955.
Last Updated On
October 26, 2021
Originally Published On
October 26, 2021