The Texas Newborn Screening Program is an essential public health program that includes:

• Laboratory bloodspot testing for more than 50 disorders
• Point-of-care screenings for 2 more conditions
• Follow-up, case management, and outreach for infants with out-of-range test results

Newborn Screening is required by law for any baby born in Texas (Health and Safety Code, Chapter 33) and identifies babies that may have a specific disorder or medical condition. Early treatment of these disorders can help prevent serious complications or even death.

Texas does not test for all of the disorders listed on the Recommended Uniform Screening Panel (RUSP). The current Texas Newborn Screening panel does not include:

• Duchenne muscular dystrophy (DMD)
• Metachromatic leukodystrophy (MLD)
• Guanidinoacetate methyltransferase deficiency (GAMT) 
• Galactoepimerase deficiency (GALE)
• Galactokinase deficiency (GALK)

View a list of the conditions on the Texas Newborn Screening Panel.

Most children born with these problems appear healthy at birth and are from healthy families. Parents who already have healthy children, or who are "silent carriers" of a genetic condition, do not expect any problems. Because every baby is tested soon after birth, children who may have one or more of these disorders can be identified early and get early care. This can make a tremendous difference in health outcomes for the child

Texas law (Health and Safety Code, Chapter 33) requires health care providers to screen all newborns for certain genetic disorders or medical conditions on the Recommended Uniform Screening Panel (RUSP). Currently, for Texas, this includes screening for 35 core conditions, 24 secondary conditions*, and two point-of-service screenings. View a list of the conditions on the Texas Newborn Screening Panel. 

*Note: The primary mission of NBS is to identify newborns at the highest risk for the core conditions. However, screening may also detect secondary conditions. Appropriate diagnostic testing determines whether a core condition or a secondary condition is present.

The newborn screen may NOT identify all babies with the disorders on the panel.  The newborn screening test identifies babies at risk of having a disorder on the panel. The number of babies with secondary conditions that are not identified by screening may be higher than for core conditions. If there are clinical symptoms or family history of a condition, the newborn screen results alone should not be used to rule out or confirm a condition; diagnostic testing should be pursued. The newborn screening results should be considered by a medical professional in conjunction with family history and diagnostic testing, when warranted. 

The term “PKU test” is outdated as well as misleading since phenylketonuria (PKU) is one of over 50 disorders on the Newborn Screening Panel. Telling a parent their newborn has an abnormal “PKU test” can be confusing. The abnormal screening result may be for a different disorder on the Newborn Screening Panel.  In addition, when calling the DSHS Laboratory to request a Newborn Screen report, it is imperative for it be referred to as the Newborn Screen in order to receive the correct results.

Your baby’s physician or other health care professional should ensure completion of the second newborn screen between 7 and 14 days of age. The Texas Department of State Health Services (DSHS) recommends collecting the second newborn screen in the infant’s medical home whenever possible.   

If your pediatrician or other health care professional does not perform the second newborn screen in-office and sends you to a hospital or another facility, that decision is based on the practices of that individual or facility. Referring families to another collection site may delay collection, increase cost, or contribute to missed screens.  The baby’s physician or other health care professional should explain the next steps, refer you to a confirmed collection site if needed, and follow up to confirm completion of the second newborn screen. 

The Affordable Care Act (ACA) classifies newborn screening as a preventative service. Insurance coverage and billing may vary when referred to a hospital or another facility for collection.   

DSHS does not have authority over how individual health care entities choose to perform collections or bill for services. If possible, families may choose a health care professional who collects the second newborn screen in the office to avoid additional steps or potential costs.    

Physicians and other health care professionals who serve Texas Health Steps patients must collect the second newborn screen during the two-week checkup visit according to THSteps policy.  THSteps providers may not refer THSteps patients back to the birthing hospital, local health department, or other health care professionals for this service.

Physicians and health care professionals should collect the second newborn screen during an in-office visit between 7 and 14 days of age. The Texas Department of State Health Services (DSHS) recommends collection in the infant’s medical home whenever possible. 

Physicians and other professionals may refer patients to another collection site; however, referrals may delay collection, increase costs for families, or contribute to missed screens.  Physicians and other health care professionals should confirm that another facility performs second newborn screen collections before making a referral.   

The Affordable Care Act (ACA) classifies newborn screening as a preventive service. When physicians or other health care professionals refer patients to another facility for collection, insurance coverage and billing may vary from services performed in a primary care office. 

Physicians and other health care professionals remain responsible for ensuring completion of the second newborn screen within the recommended timeframe.  Health care professionals should communicate with the next steps, coordinate collection when needed, and follow up to confirm completion.  Because of this, DSHS does not refer patients to specific hospitals or health care professionals.  

Physicians and other health care professionals who serve Texas Health Steps patients must collect the second newborn screen during the two-week checkup visit according to THSteps policy.  THSteps providers may not refer THSteps patients back to the birthing hospital, local health department, or other health care professionals for this service.  

Providers who want to collect newborn screens on-site should complete and submit the Submitter Identification Number Request Form to DSHS Laboratory.

DSHS screens for many but not all diseases your baby may have. More tests can be done. For more information, ask your baby’s doctor and visit www.babysfirsttest.org/find-condition or savebabies.org/resources/pregnant-families.

Note: DSHS has no affiliation with these sites and the opinions and positions of these organizations may not reflect the opinions and/or positions of DSHS.

DSHS has implemented a two-screen system to maximize the effectiveness of testing for all disorders on the Texas Newborn Screening Panel.

Two screens are completed in Texas to detect some of the disorders at the earliest possible opportunity. The first screen should be collected between 24 to 48 hours of age and the second screen between 7-14 days of age.

In Texas, the second screen routinely detects babies at risk for severe medical complications. These babies sometimes have a normal first screen. 

After a baby is born, their physiology changes rapidly and sometimes it takes a week or more for these changes to occur. In some cases, a disorder may only be detected on the second screen due to these physiological changes.  

In addition, some disorders (like cystic fibrosis) rely upon both newborn screens to reduce the number of babies who would otherwise require additional testing with a specialist to determine whether they have the condition or not. 

The goal of the Texas Newborn Screening Program is to identify babies who have these devastating diseases before symptoms arise so that they can receive appropriate treatment and lead productive and healthy lives.  Having a second screen improves medical providers’ ability to identify children with disorders who would have otherwise gone undetected.

The health care provider collects the blood sample. The DSHS Public Health Laboratory in Austin performs the newborn screening laboratory tests.

An abnormal or “out of range” test result indicates that the baby may be at higher risk of having one or more of the disorders included on the newborn screening panel. This does not mean that the baby definitely has a disorder. In fact, most babies who receive "out of range" results do not have the condition of concern. If the newborn screen indicates “out of range” results, parents are contacted by their child’s healthcare provider. It is important that parents follow their healthcare provider’s directions for their child’s immediate care and additional testing.

Most of these conditions can be treated but not cured. In these cases, early and continuous treatment can result in dramatic positive outcomes for the child and help prevent or control the serious effects of these disorders. Severe Combined Immunodeficiency (SCID), which was added to the newborn screening panel in 2012, is the one disorder on the panel that if identified early in life can be treated and for which most patients can be cured.

Healthcare providers or facilities purchase the specimen collection kits *(which includes the cost of the testing) for private pay or insurance covered patients. DSHS provides specimen collection kits at no cost for patients covered by Medicaid, CHIP, and Title V. DSHS is reimbursed by Medicaid, CHIP, and Title V for the testing performed on these kits.

A parent/guardian can only refuse to have their child screened if the screening conflicts with the parent’s religious tenets or practices (see Texas Health & Safety Code Sec. 33.012).  

There are important medical benefits of newborn screening to consider: 

• All disorders have intervention or treatment options available. 
• Prevention of complications.  
• Improved long-term health for the child. 

Newborn screening of the blood spot consists of a series of tests to look for over 50 diseases that can cause a baby to get very sick or die if they are not identified and treated early. The diseases can cause growth problems, mental or physical disability, deafness, blindness, seizures, and early death. Most babies with these conditions look healthy when born, and problems may not appear for several weeks or months. About 1 child out of every 500 screened has one of these newborn screening conditions. 

Texas law mandates newborn screening to help protect babies from health problems. The parent/guardian must sign a form stating they are refusing the screening due to their religious tenets or practices. 

If a parent/guardian has concerns, they should talk to their baby’s physician or contact the Newborn Screening Program Staff by phone at 512-776-7333 or email newbornscreeninglab@dshs.texas.gov 

Because an interpretation of the result report may be necessary, it is recommended that newborn screening results be released to physicians or medical professionals only. 

Individuals (if over 18) or parents (if under 18) may:

1. Talk to your healthcare provider. Healthcare providers can request newborn screening results for their patients by contacting DSHS Laboratory Reporting, Monday through Friday 8am to 5 pm, by either: Sending a fax request to 512-776-7533 or calling 512-776-7578. OR
2. Visit DSHS Lab Patient Results for information on how to obtain copies of your/your child’s test results.  

Because an interpretation of the result report may be necessary, it is recommended that newborn screening results be released to physicians or medical professionals only.

Individuals (if over 18) or parents (if under 18) may:

1. Talk to your healthcare provider. Healthcare providers can request newborn screening results for their patients by contacting DSHS Laboratory Reporting, Monday through Friday 8am to 5 pm, by either: Sending a fax request to 512-776-7533 or calling 512-776-7578.
2. Fill out the authorization form linked below to request the newborn screening results be sent to a specific physician. If requesting that the results be sent for university records, the school’s physician or nurse information should be included. Fax the completed form to DSHS Laboratory reporting at 512-776-7533.

Authorization to Disclose Protected Health Information (or other confidential information) Form (PDF 34kb)

The Texas DSHS Laboratory Reporting Department can provide newborn screening results from 1991 to present.

The 89th Texas Legislature passed a bill that authorizes the Texas Newborn Screening Program to screen for Duchenne Muscular Dystrophy (DMD), including follow-up services. We cannot begin DMD testing at this time because the current Texas Department of State Health Services (DSHS) Laboratory does not have space for the required equipment and supplies.

The 89th Texas Legislature also allocated funding to DSHS to build additional laboratory space. The project to build additional laboratory space began in 2025 and will take at least five years to complete. Once the additional laboratory space is complete, DSHS will obtain needed testing equipment, validate, and implement DMD screening and follow-up services.

Texas Health Steps (THSteps) providers must include the newborn screen as part of the required 2-week checkup; therefore, it is not a separate billable service. When an infant presents in the clinic for their 2-week checkup, the provider should perform the newborn screen regardless of Medicaid number assignment*.  For all Medicaid-eligible infants, collect the newborn screen specimen using the Medicaid/CHIP/Unfunded (NBS 3) collection kit, which DSHS provides free of charge to the provider.

If a provider misses the second newborn screen at the 2-week checkup, needs to repeat the screen, or needs to collect a third newborn screen for follow-up, the provider must schedule and perform the newborn screen as soon as possible. Providers must not refer clients to the delivery hospital, local health department, or another provider for this service.  

The newborn screen or capillary blood collection is not eligible for separate reimbursement. For detailed guidance on follow-up and acute care visits, providers should refer to Subsection 4.3.9, Follow-Up Visits, in the Children’s Services Handbook of the Texas Medicaid Provider Procedures Manual (TMPPM). Providers with additional questions, including billing, should contact their local THSteps Regional Provider Relations Representative for assistance.  

*NOTE- Under HB 3940 from the 89^th Legislative Session, if a newborn child of a Medicaid recipient has not yet been assigned a Medicaid identification number, the provider may accept and use the mother's Medicaid ID on any claim for reimbursement under the Medicaid program. This provision helps ensure that newborns have timely access to covered services while enrollment processing is complete. 

The Storage and Use of Newborn Screening Blood Spots form is the form used by parents or guardians to give consent to store Newborn Screening residual blood spots. This form allows the parents or guardians to decide what they want to happen with their child’s residual blood spots. No matter the parents' choice, The Texas Department of State Health Services (DSHS) will NOT release information that can identify them or their child without additional parental written consent.

The Storage and Use of Newborn Screening Blood Spots form is page 2 of the Newborn Screening Collection Kit. As of June 1, 2012, TAC 25.1.37D, Rule 37.55 requires healthcare workers to distribute the Storage and Use of Newborn Screening Blood Spots form to the parents or guardians upon collecting each newborn screening specimen.  If the parent returns the form to the provider, the provider shall ensure the completed and signed form is promptly sent to DSHS as per TAC 25.1.37D, Rule 37.56. Return the form with a specimen shipment or mail it to the DSHS NBS Laboratory address listed on the form.

*View specimens collected prior to June 1, 2012.

The DSHS NBS Laboratory recommends completely filling all preprinted circles on the filter paper section of the Newborn Screening Collection Kit. This ensures that there will be enough blood to complete all initial newborn screening and any additional testing to verify results. The blood that remains after all testing is complete is the residual dried blood spots. These blood spots have important uses for both DSHS NBS Laboratory and public health research.

By Texas Law (Health & Safety Code Sec. 33.018 (b)-(c)), the DSHS NBS Laboratory retains the residual blood spots for up to two years and may use them during that time.  DSHS NBS Laboratory keeps residual blood spots in a secure place.  The DSHS NBS Laboratory will destroy the residual blood spots within two years unless the parent or guardian permits otherwise. 

Uses within the two years include:

• Ensuring DSHS NBS Laboratory tests, equipment, and supplies are working correctly. 
• Developing new tests for newborn screening.
• Studying diseases that affect public health as allowed by law.

If the parent or guardian selects OK, DSHS will store the residual blood spots safely for up to 25 years and researchers may use them for public health research outside of DSHS. This research may include the study of public health problems such as cancer, birth defects, or other diseases. No matter the parent’s choice, DSHS will NOT release information that can identify them or their child outside DSHS without additional parental written consent. View the data use policy and the list of research uses that DSHS has allowed.
 

No. The parent or guardian can take the Storage and Use of Newborn Screening Blood Spots form, page 2 of the Newborn Screening Collection Kit, home. They can then complete, sign and mail the form at any time. Mail it to the DSHS NBS Laboratory address listed on the form, or return it to the hospital, doctor’s office, or collection facility. 

Yes, if the parent or guardian has changed their mind about the storage and use of the blood spots or if they do not remember completing one previously, then they should complete a new Storage and Use of Newborn Screening Blood Spots form, which is page 2 of the Newborn Screening Collection Kit. If the parent returns the form to the provider, the provider shall ensure the completed and signed form is promptly sent to DSHS as per TAC 25.1.37D, Rule 37.56. Return the form with a specimen shipment or mail it to the DSHS NBS Laboratory address listed on the form.

DSHS NBS Laboratory will act upon the latest valid and applicable Storage and Use of Newborn Screening Blood Spots form received.

The parent or guardian stated that they had already completed the Storage and Use of Newborn Screening Blood Spots form.  Are we, the healthcare workers, required to distribute a new Storage and Use of Newborn Screening Blood Spots form, page 2 of the Newborn Screening Collection Kit, for the second newborn screen?
 
Yes. Healthcare workers must distribute the Storage and Use of Newborn Screening Blood Spots form, page 2 of the Newborn Screening Collection Kit, to the parents or guardians upon the collection of EACH newborn screening specimen, as stated in TAC 25.1.37D, Rule 37.55.  If the parent returns the form to the provider, the provider shall ensure the completed and signed form is promptly sent to DSHS as per TAC 25.1.37D, Rule 37.56. Return the form with a specimen shipment or mail it to the DSHS NBS Laboratory address listed on the form.

Yes. Additional copies of the Storage and Use of Newborn Screening Blood Spots form is available. The parent or guardian can mail the completed form to the DSHS NBS Laboratory address listed on the form. DSHS NBS Laboratory will act upon the latest valid and applicable Storage and Use of Newborn Screening Blood Spots form received.

Yes. Healthcare providers should check the box in the lower right-hand corner of page 3 on the Newborn Screening Specimen Collection Kit Demographic form to indicate that they distributed the Storage and Use of Newborn Screening Blood Spots form.

Download an Order Form for Newborn Screening Supplies.
Complete the order form by specifying the total number of kits needed by your facility. There are two types of Newborn Screening Collection Kits: 

1. Insurance/Self-Pay (NBS 4)
   1. Use this Newborn Screening Collection Kit for newborns covered by private insurance or for those with families planning to pay out of pocket.
   2. DSHS will send an invoice for the current cost of the Newborn Screening Collection Kits.  Payment will be due within 90 days of receiving the invoice.
2. Medicaid/CHIP/Unfunded (NBS 3)
   1. Use this Newborn Screening Collection Kit for newborns eligible for Medicaid, covered by CHIP (Children’s Health Insurance Program), or those without any other payment options as required in Texas Administrative Code, Title 25 section 37.55.
   2. Unfunded, previously called charity care or uninsured, refers to patients without insurance, unable to pay out of pocket and do not qualify for coverage of newborn screening services through Medicaid, CHIP, or any other government program. This is an exception, not standard practice. 
   3. DSHS provides these kits at no charge. The no-cost specimen collection kit should only be used for a Medicaid-eligible, CHIP-eligible, or unfunded newborn, and the submitter must affirm this information on the Newborn Screening Collection kit request form.

Indicate the quantity needed on the order form. Order a quantity of kits to last 1-3 months. Return envelopes and submitter labels are provided at no charge.
The Container Preparation Group will process and ship orders within 5 business days of receipt. Please allow an additional 1-3 business days for delivery.

Container Prep Group Contact Information:
Phone: 512-776-7661
Fax: 512-776-7672
Email: containerprepgroup@dshs.texas.gov
 

To update your facility’s contact information, complete the Submitter Identification Number Request/Update Form. 

This form is used for new submitters, as well as established submitters who need to update their information. When completing the form for an update, please make sure the “Updating Submitter Information” box is checked at the top. 

Fax the completed form to Laboratory Reporting at (512) 776-7533. 

SHARING CARDS IS STRONGLY DISCOURAGED. Every effort should be made to monitor inventory and plan accordingly for ordering. ONLY share or borrow cards if absolutely necessary.

Please be aware of the potential complications with sharing/borrowing cards:

1.    The result reports for the newborn screens will go to the original facility that purchased the kits UNLESS:

2.    The borrowing facility information (including submitter ID #) is placed in the submitter information portion of the demographic form of the newborn screening kit.

3.    DSHS is not responsible for billing issues that arise when borrowing/sharing cards. Any reimbursement arrangements for shared/borrowed cards need to be made between the facilities involved.

Please see above for information on ordering Newborn Screening supplies.

The Texas Newborn Screening Program requires health care providers to collect blood spots on two separate occasions for each child. Providers must collect the first screen within 24 to 48 hours of age, or before they discharge the newborn from the hospital. They must collect the second screen between 7 and 14 days, a minimum of 168 hours, of age. 

Reference (normal) ranges are set for a specific population. The DSHS reference ranges are set for specimens collected at 24-48 hours of age and a different set for specimens collected at 7-14 days of age. In the laboratory specimens are categorized by the age of the baby when the specimen was collected.

Collection of the first screen at 23 hours may not have a large impact. To accurately detect amino acid disorders, the infant really needs time to metabolize their first protein feedings. There may not be much difference in laboratory results between 23 and 24 hours. However, if a specimen were collected at 6 or 12 or 18 hours that will probably have some impact on the metabolites that are measured and their potential to be elevated.

Collection of a second screen at 6 days could have a large impact because it can lead to false negative results for fatty acid oxidation disorders. Fatty acid markers quickly start to normalize after the first few days of life. Fatty acid oxidation abnormal ranges are higher for first screen specimens than for second screen specimens. A specimen collected at 6 days will be analyzed using first screen reference values.

The Texas NBS Laboratory accepts specimens collected on older infants, however, keep the following in mind:

• Texas is a two-screen state. Texas law requires every baby to receive newborn screening blood-spot-based tests for the conditions on the state newborn screening panel. The birth facility or midwife collects the first screen when the baby is 24 to 48 hours of age.  A pediatrician or other health care professional collects the second screen when the baby is 7 to 14 days of age, a minimum of 168 hours.
• If the infant misses the second NBS window between 7 and 14 days of age, pediatricians and other health care professionals should still collect a second newborn screen as soon as possible. 
• Perform the screen via heel stick unless the infant is walking. If the infant is walking, collect the specimen by an alternative method following standard blood collection practices.  For more information visit Alternative Methods for Collecting a Newborn Screen webpage. 
• Newborn screening targets newborns and young infants. Testing outside the recommended age range may not detect all screened conditions. If there is a clinical concern, start diagnostic testing without delay. The physician makes the final determination to proceed with newborn screening or diagnostic testing. 

See table below to determine necessity of a third screen:

Newborn Screening Clinical Care Coordination

The healthcare facility should document all attempts made to the parent/guardian and keep the documentation in the baby’s medical record.

If the baby’s 1^st screen was normal, obtain the 2^nd screen when the casts are changed or removed.

If the baby’s 1st screen was abnormal, follow Newborn Screening Clinical Care Coordination guidelines.

If the baby’s 1st screen was unsatisfactory, refer to Alternative Methods for Collecting a Newborn Screen.

The heel-stick is the preferred method for optimal laboratory results for the newborn screen. However, it is understood that certain circumstances may warrant alternative collection methods. For more information, please see the Specimen Collection – Special Circumstances web page, or the Alternative Methods for Collecting a Newborn Screen page.

Visit the DSHS Specimen Collection Requirements page or the Healthcare Provider Resources page.

Quick tip: Save these webpages as favorites for easy access whenever needed.

A parent/guardian can only refuse the newborn screen blood test for religious reasons (Texas Health & Safety Code Sec. 33.012). 

There are important medical benefits of newborn screening to consider: 

• All disorders have intervention or treatment options available. 
• Prevention of complications.  
• Improved long-term health for the child. 

Healthcare providers play an important role in educating families. Ensure all staff are familiar with the benefits of screening and the negative outcomes that can occur if the baby is not screened. Provide the information outlined above to parents/guardians who are considering refusing the screen. The only legal reason to refuse newborn screening is if it conflicts with the parent/guardian’s religious tenets or practices. 

After education and discussion with the parent/guardian, answering all questions, the parent/guardian may still refuse. The provider must document the refusal in the patient medical record. Providers can use a self-developed form or may use the form provided by DSHS. 

The DSHS Newborn Screen Blood Test Refusal Form provides: 

• Instructions on how to complete the form. 
• QR Code to view short video featuring families affected by disorders on the Texas NBS panel. 
• Discussion prompts for parent education. 
• Parent/Guardian acknowledgement statements and signature for record keeping. 

Newborn Screen Blood Test Refusal Form: English / Spanish 

No. One kit is required for each screen. Each child will require two screening test kits.

It is understood that it may not be possible to send all specimens as soon as possible after collection, especially for those specimens drawn before weekends or mail holidays. Specimens should be dried thoroughly and sent to DSHS as soon as possible, preferably by overnight courier.

Rules emphasize the importance of the timely collection and mailing of specimens so that children with these disorders can be identified, diagnosed and treated quickly. However, the first priority is to provide an acceptable specimen. Do not ask the parent/child to return later as this will delay the screening. Do not ship specimens wet.

New national recommendations state that first screen specimens should arrive at the DSHS Laboratory within 24 hours after collection. Ideally, specimens should arrive the day after collection. 

• DO NOT delay shipment of newborn screening specimens. Ship dried specimens as soon as possible, preferably via overnight courier. If mail or courier services are unavailable, ship as quickly as possible.

• DO NOT batch or hold dried specimens for shipping.

• Ship dried specimens directly from the collection facility to the DSHS Newborn Screening Laboratory.

Identify internal processes which may delay shipment and look for possible improvements. 

See Decreasing Time Between Collection of Newborn Screening Specimens to Receipt in DSHS Laboratory (PDF 861kb)

The information in the “mother information” section of the Newborn Screening kit should reflect who the child will be in the care of upon release from the health care facility. We require this information for multiple laboratory and follow-up purposes. Most importantly, it is necessary for the Newborn Screening Clinical Care Coordinators to have accurate contact information of the child’s caregiver if there is an abnormal newborn screen.

There are two types of Newborn Screening Collection Kits

• Insurance/Self-Pay (NBS 4)
  • Use this Newborn Screening Collection Kit for newborns covered by private insurance or for those with families planning to pay out of pocket.
• Medicaid/CHIP/Unfunded (NBS 3)
  • Use this Newborn Screening Collection Kit for newborns eligible for Medicaid, covered by CHIP (Children’s Health Insurance Program), or without any other payment options as required in Texas Administrative Code, Title 25 section 37.55. 
  • Unfunded, previously called charity care or uninsured, refers to patients without insurance, unable to pay out of pocket and do not qualify for coverage of newborn screening services through Medicaid, CHIP, or any other government program. This is an exception, not standard practice.

Note: If you do not have the appropriate Newborn Screening Collection Kit, use the NBS Collection Kits you have on hand. Do not send the baby away. Call the Newborn Screening Laboratory at 512-776-7585 for further guidance.

Please submit the specimen on the kit collected. DO NOT ALTER THE KIT IN ANY WAY. DSHS performs data analyses to identify Medicaid eligible specimens collected on Paid / Insurance cards. If a Medicaid eligible patient has a specimen collected on a Paid / Insurance card, the facility’s account will be credited for the cost of the kit.  The data analysis and reimbursement process takes 6 - 9 months.

Please submit the specimen. Note on the collection kit that the specimen should have been collected on an Insurance / Self-Pay card. DSHS will bill the facility for the cost of the kit.

If the mother of the infant is Medicaid-eligible at the time of the infant’s birth, collect the newborn screening (NBS) specimen using the Medicaid/CHIP/Unfunded kit. Perform the NBS regardless of Medicaid number assignment, do not delay collection. 

Under HB 3940 from the 89^th Legislature Session, if a newborn child of a Medicaid recipient has not yet been assigned a Medicaid identification number, the provider may accept and use the mother's Medicaid ID on any claim for reimbursement under the Medicaid program. This provision helps ensure that newborns have timely access to covered services while enrollment processing is complete. 
 

In this scenario, the provider should use the Medicaid card.

Yes. STAR plans are Medicaid- managed care plans. Patients seen under these plans are eligible for Medicaid. You will not be charged for kits for Medicaid-eligible, CHIP, and unfunded newborns.

No, do not delay scheduling the 2-week checkup. The provider should perform the newborn screen regardless of Medicaid number assignment. For all Medicaid-eligible infants, collect the newborn screen specimen using the Medicaid/CHIP/Unfunded (NBS 3) collection kit, which DSHS provides free of charge to the provider.

The provider should obtain the newborn screen as part of the 2-week checkup between 7 and 14 days of age, and it is a required component of the THSteps 2-week checkup; therefore, it is not a separate billable service. Providers must not refer clients to the delivery hospital, local health department, or another provider for this service.  

Under HB 3940 from the 89^th Legislative Session, if a newborn child of a Medicaid recipient has not yet been assigned a Medicaid identification number, the provider may accept and use the mother's Medicaid ID on any claim for reimbursement under the Medicaid program. This provision helps ensure that newborns have timely access to covered services while enrollment processing is complete.

DSHS accepts exchange requests beginning the day after the kits expire. Submitters may request exchanges for up to three months after the expiration date. DSHS will not accept exchange requests after this three-month period.

No, you do not need to return Medicaid/CHIP/Unfunded (NBS 3) Kits to DSHS for exchange since they were free of charge. Discard expired Medicaid/CHIP/Unfunded (NBS 3) Kits in the regular garbage, recycle them with paper, or shred them. 

Expired and unused NBS specimen collection kits can be discarded in the regular garbage, recycled with paper recycle, or shredded.

Complete the G-6D “Newborn Screening Supplies” order form. Count the number of expired NBS4 kits. Write the number of forms to be exchanged in the “Quantity Requested” box and write “Exchange” in the “Billing – Purchase Order Number” box section of the form. 

The completed G-6D form and expired kits should be mailed to: 

For Overnight/Priority Shipping (UPS, DHL, FedEx, etc): 

Texas Department of State Health Services

Container Preparation Group

Laboratory Services Section, MC 1947

1100 W. 49th Street

Austin, TX 78756-3199 

For regular mail: 

Texas Department of State Health Services

Container Preparation Group

Laboratory Services Section, MC 1947

PO Box 149341

Austin, TX 78714-9341 

The cost for shipping is the responsibility of the submitter. 

Allow DSHS 5 business days from receipt of exchange request to process the request.

Although the same form is used to both request an exchange of expired forms and to order new kits, a separate form must be filled out for each type of request. If additional new kits are ordered on the same G-6D form as the request for exchange of expired kits, only the exchange request will be processed.

Example: 20 expired kits are sent in for exchange and 100 additional kits are requested on the same G-6D form. DSHS will only send out 20 new kits to cover the number returned for exchange. 

No, DSHS will only accept requests to exchange kits that have already expired. 

You have up to 3 months after the expiration date to submit a request to have expired NBS4 kits exchanged for non-expired kits.

No. When an exchange request is received, DSHS will automatically send new kits for the exact number of kits that were returned. 

No. Expired NBS4 kits cannot be returned for a refund or credit. DSHS will automatically process the request as an exchange. 

1. Fill out:

• Facility Security Agreement (PDF 40kb) (1 per facility) AND
• Web User Access Agreement (PDF 41kb) (1 for each user)

2. Submit the completed forms:

• Fax to: 512-776-7223, Attn: Remote Lab Support, L-601
• Or e-mail to: mailto:remotelabsupport@dshs.texas.gov

For help, call: 512-776-2484 or 512-776-6275.

A Newborn Screening Submitter ID is required to complete this paperwork. If the facility does not have a Submitter ID, see the next question and answer below.

Yes, you can. Health care providers do NOT need to collect newborn screening specimens to access results online.

Metabolic specialists, endocrinologists, pediatricians, and other health care providers often need fast access to newborn screening results. While your facility does not have to submit specimens, you must have a submitter ID number to access results through the online system.

Requesting a Submitter ID Number

• Complete the Submitter Identification Number Request Form.
• In section 4 of the Submitter Identification Number Request Form, “Please select the type of test that will be requested:” write “None. Need online access to NBS results.”
• Fax to Laboratory Reporting at (512) 776-7533.
• If you want to use a submitter ID number from an associated facility, call 512-776-7578, for assistance.

Once you have obtained a submitter ID number, sign up for online access by visiting Remote Data Systems | Texas DSHS. 

The Newborn Screening Report Card provides a monthly report on your facility’s NBS submissions; including number of specimens submitted and specific information on specimen quality and demographic issues.

Refer to the Guide to the Newborn Screening Report Card (PDF 111kb) for more information on each category.

Access to the report allows the facility to:

• Identify strengths and opportunities for improvement.

• Compare your facility’s performance with others in the state.

To access your facility’s report card, you must be a registered user of the Texas Newborn Screening Web Application (Neometrics). If you are not already a registered user, you can sign up to become a registered user of the Texas Newborn Screening Web Application.

Send an email request for a password reset to remotelabsupport@dshs.texas.gov. Business hours for assistance are 8am-5pm Monday through Friday.

Results will be available in the web application 4 to 7 working days (Monday - Saturday) after receipt of the specimen, in most cases.

Results will be available indefinitely. Currently, users can access results for any specimens reported after mid-February of 2007. To access result reports for earlier specimens, providers must contact the DSHS Laboratory Reporting Group (fax 512-776-7533 or call 512-776-7578).

Call DSHS Laboratory Reporting at 512-776-7578 to request to opt out of hard copy reports.

To view result reports, the web application requires Adobe Reader 8.0 or higher. If you have an older version, this error will occur. Update your version of Adobe Reader.

Yes. In the Access Result Reports module, uncheck Submitted Samples Only before performing a search. For additional security purposes, the user must use a combination of multiple search fields to access the result report. Recommended search criteria for SRV criteria. (PDF).

The web application includes features that maximize patient privacy and ensure compliance with HIPAA Security rules.

If you are having trouble accessing results for a patient, check out the general SRV search tips (PDF) or send an email request for assistance with the website to: mailto:NBSRemoteDataServices@dshs.texas.gov.

A few quick reminders:

• Search with as few fields filled in as possible.

• If there are any differences between what is searched for and what is in the system, results will not be retrieved.

• The search combinations outlined in the Search Tips document (linked above) are the ONLY combinations allowed when searching for results for specimens that were not submitted by your facility.

• When searching for results for specimens submitted by another facility, you must un-check the “Submitted Samples Only” box.

The following is a list of just some of the label printers that have been tested with this system. Other similar printers will likely be configurable as well.

• Zebra LP2824

• Zebra TLP 3742

• DYMO Label Writer 400 Turbo

• Brother P-touch QL-5000

• SII Smart Label Printer

For complete instructions for configuring your printer and web browser, download  Lab NBS Provider Web Installation (PDF 834KB)

No. If you place a web label on the NBS card, you do not have to complete the form.

Through the web system, you may re-access the submitted specimen using the Search option under the Enter NBS Demographics module. Choose to edit the demographics for the specimen in question. Make any necessary changes to the demographic information and submit the specimen again. You will then be prompted to print a label.

If your printer is configured to initiate a print dialog at each print, there will be an option to choose the number of copies within that dialog. If you will always print multiple labels, the number of copies can be set in the printer preferences.

Although the system is configured to print to a label printer, if you prefer to print to labels on a laser printer see PDF directions located at: NBS Procedure Print Label Web Application (PDF) 

There is not a default setting to automatically print labels to the label printer and other documents to the networked printer. If you have the default set to the label printer but want to print documents to another printer, you will have to either change the default printer to the laser one you wish to print to, or select the laser printer from the print dialog box.

Since this is a secure site, the site must be added to a list of acceptable sites under security settings for your web browser. This may require setup assistance from your facility’s IT department. The steps necessary to reconfigure this are also available in the document  Lab NBS Provider Web Installation (PDF 834KB)

DSHS considered billing patients, but found that administrative costs would more than double the cost of the service. Minimizing administrative costs by charging providers for screening kits represented the most cost-effective approach.

Each screening test kit qualifies as a medical device. If a kit does not perform as it should, please notify the DSHS Newborn Screening Laboratory by email. DSHS will investigate, and kits found to be defective will be replaced free of charge.

Providers are responsible for ensuring specimen quality. 

For insurance and self-pay Newborn Screening Collection kits, healthcare providers must purchase a replacement kit.

For patients covered by Medicaid, CHIP, or Title V, DSHS provides the Newborn Screening Collection Kit no cost. 

Yes; however, there are caveats depending on the type of health plan.

Federally recommended newborn screenings are part of the comprehensive preventive health guidelines supported by the Health Resources and Services Administration (HRSA) for infants and children (Section 2713 of the Public Health Service Act). Health plans are required to cover screenings included in the HRSA-supported comprehensive guidelines without charging a co-payment, co-insurance, or deductible for plan years beginning on or after the date that is one year from the Secretary’s adoption of the condition for screening. However, there are many plans that were grandfathered and are not subject to this provision. Grandfathered health plans are typically plans issued before March 23, 2010.

The full list of federally-recommended newborn screening conditions:  https://www.hrsa.gov/advisory-committees/heritable-disorders/rusp/index.html.

At the state level, Texas Insurance Code 1367.003 requires Texas regulated health plans to provide certain health coverage for newborn children including newborn screening. This addition to the law became effective September 1, 2019 and only applies to a health benefit plan delivered, issued for delivery, or renewed on or after January 1, 2020.

Doctors and health care facilities should work with health plans to ensure that newborn screening is included as a benefit in their contracts and that the health plans are aware of the cost for newborn screening.

DSHS will post the new cost to the DSHS NBS website and send out electronic notifications via the newborn screening distribution list, at minimum, 90 days prior to the effective date. 

1. Contact each health plan or insurance company to update your facility’s contracts. 
2. Check that the HCPCS code S3620 matches the current cost of the NBS Collection Kit.
3. Use HCPCS code S3620 to bill for the full cost of the NBS Collection Kit. Do NOT bill separately for each condition on the panel. 

Billing Notes

• You may charge reasonable collection and processing fees in addition to the NBS Collection Kit cost.
• You may also use CPT code 36416 to bill for collecting a capillary blood sample.
• You are responsible for extra costs not included in the NBS Collection Kit price, such as preparing and shipping specimens to the DSHS Laboratory.  

First, contact the health plan or insurance company to seek resolution.

  If no resolution is identified:

• For Texas Regulated Health Plans (Fully Insured and HMOs), contact:

Texas Department of Insurance.

https://www.tdi.texas.gov/hprovider/providercompl.html or 1-800-252-3439

• Self-Funded Plans regulated at the federal level (Most people who have health insurance in Texas have a self-funded plan), contact:

U. S. Department of Labor
Division of Technical Assistance and Inquiries
PWBA N5619

200 Constitution Ave. NW
Washington DC 20210
1-866-444-3272

• If insurance is provided by a school district, city, county or state government, a union, or church, work directly with the health plan.

Note: DSHS does not control how insurance companies operate or the reimbursement rates that are set.

TDI maintains resources for providers as does TMA and THA.

Other Resources:
Texas Department of Insurance: https://www.tdi.texas.gov/hprovider/providercompl.html

Texas Medical Association: https://www.texmed.org/newborn/
Texas Hospital Association: https://www.tha.org

Healthcare providers or facilities are responsible for purchasing Newborn Screening Collection Kits for private pay or insurance covered patients. The cost covers testing, result reporting, and any follow up provided by clinical care. The person or facility that orders the Newborn Screening Collection Kit receives a bill from the Department of State Health Services (DSHS) at the prevailing rate that is in effect when they place the order. DSHS bills the kits as customers order them, not when they submit them for testing.

For patients covered by Medicaid, CHIP, or Title V, DSHS provides the Newborn Screening Collection Kits at no cost. DSHS is reimbursed by Medicaid, CHIP, and Title V for testing performed on these kits. 

Providers submit the claim for the THSteps 2-week checkup using the infant’s Medicaid number. If the infant does not yet have his or her own Medicaid number, providers may submit the claim using the mother’s Medicaid number when the mother has Medicaid coverage at the time of birth. Infants whose mothers had Medicaid at delivery receive Medicaid benefits until they turn one year of age.

Some managed care organizations (MCOs) require providers to add the suffix “NB” to the end of the mother’s Medicaid number to indicate that the claim is for the newborn. Providers must verify requirements with each MCO.

No, Texas Health Steps (THSteps) providers must include the newborn screen as part of the required 2-week checkup; therefore, it is not a separate billable service.

The newborn screen or capillary blood collection is not eligible for separate reimbursement. For detailed guidance THSteps Medical Checkups, providers should refer to Subsection 4.3.6, THSteps Medical Checkups, in the Children’s Services Handbook of the Texas Medicaid Provider Procedures Manual (TMPPM). Providers with additional questions, including billing, should contact their local THSteps Regional Provider Relations Representative for assistance.

DSHS must evaluate and adjust the fee of the newborn screening kit to recover the costs of: specimen processing, laboratory testing, and follow-up services. Most often the cost of these services increase due to adding disorders to the testing panel.  

The Newborn Screening Collection Kit fee supports the full cost of operating the Texas Newborn Screening Program. 

The fee includes:   

• Direct costs for laboratory supplies, staff labor, specimen collection kits, the laboratory information management system (LIMS), and testing equipment. 
• Indirect costs for quality assurance and safety programs, building operations, administration, IT support, purchasing, and courier service for transporting specimens to the laboratory.  
• Follow-up notification and care coordination for infants with out-of-range laboratory results.  

DSHS calculates the fee using a procedure approved by the DSHS Chief Financial Officer. This method determines all DSHS Laboratory fees. 

Yes. Both screens are required as listed in the Texas Administrative Code, Title 25 Section 37.56. Also, some of the disorders screened are more likely to be detected when the baby is more that one week old. 

DSHS Recommended Solution:

Use the Texas Newborn Screening Web Application (Neometrics). Benefits include:

• Provider can opt to enter patient demographic information (reduces miss interpretation of hand written information on the kits) and/or

• Search and view/print newborn screening result reports 24/7

Two ways the Texas Newborn Screening Web Application (Neometrics) helps you meet the new CAP requirement for NBS tracking:

1.    Electronically submit the demographic information for each newborn screen (NBS) specimen to the DSHS Laboratory. Once the specimen is received and scanned into the Laboratory Information Management System (LIMS), it will appear as “merged” in the provider’s Texas Newborn Screening Web Application account.

2.    Search for any newborn screening specimen submitted and view or print the result report. The DSHS Laboratory Quality Assurance Group has consulted with CAP and confirmed that healthcare providers can meet the specimen tracking requirement by confirming receipt of a result report for each specimen submitted. (Note: Demographic entry of specimens as described in above option is NOT needed in order to view/retrieve result reports.)

If you are not already a registered user of the Texas Newborn Screening Web Application, access the required forms and learn more information on the benefits of signing up here:

• /lab/remotedata.shtm
  
  Required forms:

• /laboratory-services/laboratory-testing-services-manual-forms-laboratory-fee-schedule

Alternate manual method:

NBS submitters can also opt to maintain a list of each NBS specimen submitted to the DSHS laboratory in the form of a manifest and reconcile the list upon receipt of the NBS result report. (A manifest does not need to be forwarded to the DSHS Laboratory.)

Yes, if necessary, but this practice is highly discouraged. It is preferred that each site request/receive its own submitter number.

All supplies, patient results, mailed correspondence, and alerts will be sent only to a single address for the Submitter ID number given. Separate submitter IDs for separate locations improves the timeline for submitter receipt of test result reports and ability to track supply shipments. It will also help ensure that supplies are received specifically by the site that ordered them. 

A false positive test result occurs when a test indicates that a person has a particular disorder when they actually are not affected by the condition.

A false negative test result occurs when a test indicates that a person does not have the particular condition when in fact they do have it. 

Each state develops their own screening test cutoffs, which are appropriate for their state’s population. Screening test cutoffs are calculated to allow for identification of babies with the disorder while minimizing both false positive and false negative results. In Texas, screening test cutoffs are determined by performing a study to identify the level of the analyte(s) that is indicative of the disorder. The study takes into account published data, the test method, and the type of equipment that will be used. Cutoffs for certain disorders also require considering infant specific factors such as age of the baby at specimen collection, birthweight, prematurity and transfusion status.  A sufficient number of specimens representing the Texas newborn population and true positive specimens, if available, are tested to determine the range where we would expect results from babies without the disorder to fall.  If a baby has results outside this range, then those results would be considered abnormal and would require additional testing.  Test cutoffs are routinely re-evaluated by comparison to diagnosed case test values and false negative specimen results. In addition, the cutoff may also be revised to reduce the number of false positive results.