Teen C
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Teen C
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Data source: Martin JA, Hamilton BE, Osterman MJK, Driscoll AK. Births: final data for 2019. Natl Vital Stat Rep. 2021;70(2):1–50.
References
Martin JA, Hamilton BE, Osterman MJK, Driscoll AK. Births: final data for 2019. Natl Vital Stat Rep . 2021;70(2):1–50.
Martin JA, Hamilton BE, Osterman MJK, Driscoll AK. Births: final data for 2018. Natl Vital Stat Rep . 2019;68(13):1–47.
Santelli J, Lindberg L, Finer L, Singh S. Explaining recent declines in adolescent pregnancy in the United States: the contribution of abstinence and improved contraceptive use. Am J Public Health . 2007;97(1):150–6.
Lindberg LD, Santelli JS, Desai S. Understanding the decline in adolescent fertility in the United States, 2007–2012. J Adolesc Health . 2016:1–7.
Sedgh G, Finer LB, Bankole A, Eilers MA, Singh S. Adolescent pregnancy, birth, and abortion rates across countries: levels and recent trends. J Adolesc Health . 2015;56(2):223–30.
Romero L, Pazol K, Warner L, et al. Reduced disparities in birth rates among teens aged 15 to 19 Years—United States, 2006–2007 and 2013–2014. MMWR Morbid and Mortal Wkly Rep . 2016;65(16):409–414.
Penman-Aguilar A, Carter M, Snead M, Kourtis A. Socioeconomic disadvantage as a social determinant of teen childbearing in the US Public Health Rep . 2013;128(suppl 1):5–22.
Boonstra HD. Teen pregnancy among women in foster care: a primer. Guttmacher Policy Review . 2011; 14(2).
National Campaign to Prevent Teen and Unplanned Pregnancy, Counting It Up: The Public Costs of Teen Childbearing 2013 external icon . Accessed March 31, 2016.
Perper K, Peterson K, Manlove J. Diploma Attainment Among Teen Mothers. Child Trends, Fact Sheet Publication #2010-01: Washington, DC: Child Trends; 2010.
Hoffman SD. Kids Having Kids : Economic Costs and Social Consequences of Teen Pregnancy . Washington, DC: The Urban Institute Press; 2008.
Power to Decide. Progress Pays Off pdf icon external icon . Accessed January 10, 2019.
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The US teen birth rate (births per 1,000 females aged 15 to 19 years) has been declining since 1991. Teen birth rates continued to decline from 17.4 per 1,000 females in 2018 to 16.7 per 1,000 females in 2019. This is another record low for US teens and a decrease of 4% from 2018. 1,2 Birth rates fell 7% for females aged 15 to 17 years and 4% for females aged 18 to 19 years. 2
Although reasons for the declines are not totally clear, evidence suggests these declines are due to more teens abstaining from sexual activity, and more teens who are sexually active using birth control than in previous years. 3, 4
Still, the US teen birth rate is substantially higher than in other western industrialized nations, 5 and racial/ethnic and geographic disparities in teen birth rates persist. 1,2
Teen birth rates declined from 2018 to 2019 for several racial groups and for Hispanics. 1,2 Among 15- to 19-year-olds, teen birth rates decreased:
Rates for non-Hispanic American Indian/Alaska Natives (AI/AN), non-Hispanic Asians, and non-Hispanic Native Hawaiian, and other Pacific Islander teenagers were unchanged.
In 2019, the birth rates for Hispanic teens (25.3) and non-Hispanic Black teens (25.8) were more than two times higher than the rate for non-Hispanic White teens (11.4). The birth rate of American Indian/Alaska Native teens (29.2) was highest among all race/ethnicities. 1
Geographic differences in teen birth rates persist, both within and across states. Although among states with low overall teen birth rates, some counties have high teen birth rates. 6
Social determinants of health, such as low education and low income levels of a teen’s family, may contribute to high teen birth rates. 7 Teens in certain settings are at higher risk of teen pregnancy and birth than other groups. For example, young women living in foster care are more than twice as likely to become pregnant than young women not in foster care. 8
To improve the life opportunities of adolescents facing significant health disparities and to have the greatest effect on overall US teen birth rates, CDC uses data to inform and direct interventions and resources to areas with the greatest need.
Teen pregnancy and childbearing are associated with increased social and economic costs through immediate and long-term effects on teen parents and their children.
Evidence-based teen pregnancy prevention programs have been identified by the US Department of Health and Human Services (HHS) Teen Pregnancy Prevention Evidence Review external icon , which used a systematic process for reviewing evaluation studies against a rigorous standard. The Evidence Review covers a variety of diverse programs, including sexuality education programs, youth development programs, abstinence education programs, clinic-based programs, and programs specifically designed for diverse populations and settings. In addition to evidence-based prevention programs, teens need access to youth-friendly reproductive health services and support from parents and other trusted adults, who can play an important role in helping teens make healthy choices about relationships, sex, and birth control. Efforts at the community level that address social and economic factors associated with teen pregnancy also play a critical role in addressing racial/ethnic and geographical disparities observed in teen births in the United States .
• Newborn and well-baby checkups
• School
• Camp or athletic physicals
• Routine well-child care
• Family planning visits
• Special Supplemental Food Program for Women Infants and Children (WIC)
• Head Start physicals
• Immunizations
• Initial prenatal visits
• Early childhood screening
• Foster care evaluation and screening
• A Minnesota Health Care Programs (MHCP) C&TC
A C&TC clinic or a facility supervised by a physician that provides screening according to EPSDT
• Nurse practitioners
• Physicians
• Physician assistants
• Dentists
• Public health nurses
• Registered nurses
• Other staff through delegation by a licensed health professional within their scope of practice
• C&TC
• Community health
• Dental
• Physicians
• Public health
• Public health nursing
• Rural health
• School (clinics)
• Family planning agencies
• Federally qualified health centers
• Head Start
• Hospitals
• Indian Health Services
• WIC
• Health education (anticipatory guidance)
• Physical growth and measurement (height, weight, head circumference, weight for length percentile and BMI at appropriate ages)
• Health history, including social determinants of health, and nutrition
• Developmental health
• Social-emotional or mental health
• Autism spectrum disorder screening
• Postpartum depression screening
• Tobacco, alcohol or drug risk assessment
• Physical examination (includes but not limited to: pulse, respiration, blood pressure, exam of head, eyes, ears, nose, mouth, pharynx, neck, chest, heart, lungs, abdomen, spine, genitals, extremities, joints, muscle tone, skin and neurological condition)
• Immunizations and review of immunizations
• Newborn screening follow up: blood spot and critical congenital heart defect
• Laboratory tests or risk assessment including:
• Blood lead test
• Hemoglobin or hematocrit
• Hepatitis C
• Tuberculosis
• Sexually transmitted infection (STI) risk assessment, with lab testing for sexually active youth
• Human immunodeficiency virus (HIV) screening lab test
• Dyslipidemia risk assessment
• Vision screening (visual acuity screening, plus lens, beginning at age 5)
• Hearing screening (addition of 6,000 Hz screening for age 11 and over)
• Oral Health, including fluoride varnish application (FVA) starting at eruption of the first tooth through the age of 5 years. FVA application is limited to four per 365 days
• CPT code 96110 for a developmental screening with a standardized instrument
• CPT code 96127 for a social-emotional or mental health screening with a standardized instrument
• CPT code 96110 (for the developmental screening)
• CPT code 96110 and modifier U1 (for the ASD-specific screening)
• Primary care practitioner
• Medical specialist, such as a developmental pediatrician
• Mental health professional
• Comprehensive Multi-Disciplinary Evaluation (CMDE) providers (search “Early Intensive Developmental and Behavioral Intervention” and then “CMDE assessments” via MHCP Provider Directory )
• Local school district for educational evaluation (directly or via Help Me Grow )
• Local community service agency, when appropriate (directly or via Help Me Connect )
• Use CPT code 96161
• Use the child’s MHCP member ID number
• Bill it on the same claim as the C&TC screening or other pediatric visit
• Bill on the same date as a child’s developmental screening (96110) or a social-emotional screening (96127)
• American Academy of Pediatrics (AAP) Bright Futures Guidelines and Pocket Guide which includes information about early to late adolescence visits
• Bright Futures Tool and Resource Kit – contains previsit questionnaires for the adolescent and for the parent or caregiver
• C&TC for Adolescents and Young Adults, 11-20 Years - Minnesota Department of Health – information and resources about the adolescent health visit for providers and resources for parents
• One baseline Hb or Hct screening is required between 9 and 15 months of age.
• One Hb or Hct screening is required between 12 and 20 years of age for all menstruating females
• Have had recent close contact with people with infectious TB disease
• Foreign-born children and children with foreign-born parents from high-prevalence areas
• Have traveled to areas with endemic TB
• Children with (or children in households with) socioeconomic risk factors such as homelessness, living in shelters, or incarceration. Screen any high-risk person who has not received TB testing previously
• American Academy of Pediatrics (AAP) Bright Futures Guidelines and Pocket Guide
• Bright Futures Tool and Resource Kit (contains previsit questionnaires for the adolescent and for the parent or caregiver)
• Minnesota Department of Health Adolescent Health Care website (information and resources about the adolescent health visit, including resources for parents)
• Provide an oral health screening, anticipatory guidance and education for children and their families at every C&TC screening.
• Verbally refer children to dentists at the time of the eruption of the first tooth or no later than 12 months of age.
• FVA is required for infants upon eruption of the first tooth or no later than 12 months of age at each C&TC visit through age 5 years. Staff applying fluoride varnish must successfully complete an approved FVA training course . The following types of trained staff may perform FVA:
• Physicians
• Physician assistants
• Nurse practitioners
• Nurses
• Clinical staff under the direct supervision of a physician or other qualified health care professional
• Other licensed or certified health care professionals in a community setting if under the direct supervision of a treating physician (or other qualified health care professional) or dentist
• Primary care providers bill FVA on the same claim as the other C&TC services. MHCP reimbursement rate is per procedure (not per tooth). The payment for FVA is in addition to the C&TC “bundled rate” for a complete C&TC screening visit.
• When providing FVA at other pediatric visits, bill FVA on the same claim as the other pediatric services.
• FVA is limited to four per 365 days.
• CPT code 99188: trained licensed or certified health care professionals in a community setting under the direct supervision of a treating physician or other qualified health care professional.
• CDT code D1206: trained licensed or certified health care professionals in a community setting under the direct supervision of a treating dentist.
• Oral health history
• Clinical open-mouth assessment
• Topical fluoride mandatory at eruption of first tooth through age 5
• Fluoride supplementation (as indicated by clinical findings)
• Anticipatory guidance or counseling
• Counseling on the following:
• Oral hygiene
• Dietary
• Injury prevention and mouth guard recommendations
• Non-nutritive habits
• Speech and language development
• Substance abuse
• Intraoral or perioral piercing
• Provide an oral health exam, anticipatory guidance and education for children and their families at every C&TC screening. Refer to the Oral Health Screening Fact Sheet for more information.
• Verbally refer children to dentists at the time of the eruption of the first tooth or no later than 12 months of age.
• Interperiodic or interim screenings may be done as indicated and are reimbursable as a C&TC screening if all component requirements are met
• Additional screening services or specific screening components may be provided at other intervals as medically indicated
• Diagnosis and treatment of health conditions determined to be medically necessary
• Follow all billing policy requirements for submitting a C&TC screening claim
• Report one of the HIPAA compliant referral codes (ST, S2, AV or NU)
• Use the claim reporting and medical documentation for the exception reasons as appropriate
• Child has a diagnosis of a hearing or visual impairment
• Child has new glasses (identified visual impairment). Therefore:
• Completing a vision screening may not be indicated at this time
• Refer child or parent for ongoing monitoring or treatment
• Child has been diagnosed as having an autism spectrum disorder (ASD) or developmental delay. Therefore:
• Completing a developmental screening may not be indicated
• Refer child or parent for ongoing treatment or services for the condition, or both
• Maintain specific documentation of the diagnosis in the medical record of the child
• Report the correct CPT code for the screening component on the claim
• Enter an additional diagnosis code identifying the condition.
• Enter $0.00 or $0.01 as the submitted charge
• Hearing or vision screening was recently performed at a C&TC visit or by another provider or in another setting, such as at school
• Mental health screening was recently performed (within last year) for youth aged 12 and older
• Document or request and review test results at the time of the visit. If results are within acceptable limits, add specific documentation and maintain a copy of the test results in the medical record of the child
• Report the correct CPT code for the screening component on the claim
• Enter $0.00 or $0.01 as the submitted charge
• Report the correct CPT code for the screening component on the claim
• Enter $0.00 or $0.01 as the submitted charge
• Document date FVA was provided in the medical record
• Report the correct CPT code for the screening component on the claim
• Enter $0.00 or $0.01 as the submitted charge
• Rescheduling for a later date is not feasible
• Against personal or religious belief of the parent or family
• Provide specific documentation of the parent or teen or young adult refusal
• Report the correct CPT code for the screening component on the claim
• Enter $0.00 or $0.01 as the submitted charge
• Rescheduling for later date is feasible (parent or young adult is willing)
• Parent indicates they do not want the component completed because of time constraints or mood of the child
• Reattempt the screen component within 30 days
• If reattempting to screen, wait to bill the C&TC screening until all components are completed
• Bill using the two separate dates if within the same month
• If the second screening attempt crosses over to a new month, use the date the C&TC screening was finally completed
• Rescheduling for a later date is not feasible
• A valid attempt was made to complete the service
• Provide specific documentation of the unsuccessful attempt
• Report the correct CPT code for the screening component on the claim
• Add the modifier 52 to the claim
• Enter your usual and customary charge
• Rescheduling for later date is feasible
• The child is not cooperating to allow component to be completed at that time
• A diagnosis has been found that would affect the validity of the screening (that is, child has ear infection, pink eye)
• Reattempt to screen the component within 30 days
• If reattempting to screen, wait to bill the C&TC screening until all components are completed
• Bill using the two separate dates if within the same month
• If the screening crosses over to a new month, use the date the C&TC screening was finally completed
• Do not report the developmental screening code as a separate line item on the claim
• Wait to bill the completed screening until the parent-report is received and reviewed
• Bill using the two separate dates if within the same month—the date the C&TC screening was started, and the date the completed screening instrument was reviewed
• If the review of the screening instrument, crosses over to a new month, use the date the C&TC screening was finally completed
• Clinic visits or well-child screenings that do not meet C&TC screening requirements may be covered through other MHCP services such as physician services
• Services provided by a non-C&TC provider
• Do not bill counseling and risk factor reduction E&M codes with comprehensive pre
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