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36.3.7 Telemedicine Services
Telemedicine is a benefit of the Texas Medicaid Program. Telemedicine is defined as a method of health-care service delivery used to facilitate medical consultations by physicians to health-care providers in rural or medically underserved areas (MUAs) for purposes of patient diagnosis or treatment that requires advanced telecommunications technologies, including interactive video consultation, teleradiology, and telepathology.
A rural area is defined as a county with a population of less than 50,000 people.
An underserved area is one that meets the definition of a MUA or medically underserved population (MUP) by the U.S. Department of Health and Human Services (HHS).
No separate reimbursement is made for the cost of telemedicine hardware and/or equipment, videotapes, and transmissions. Telephone conversations, chart reviews, email messages, and faxes alone do not constitute a telemedicine interactive video consultation and, therefore, are not considered for reimbursement. Only those services that involve direct face-to-face interactive video communication with the client, remote, and hub site providers are reimbursed; unless the service may currently be considered for reimbursement using telemedicine, without face-to-face contact, i.e., teleradiology and telepathology.
Telemedicine services are reimbursed only when provided through systems meeting minimum technical specification standards, as identified by HHSC, the Texas Utilities Commission, or as otherwise authorized.
In both the traditional and managed care systems, THSteps (Early and Periodic Screening, Diagnosis, and Treatment [EPSDT]) visits will not be considered for reimbursement if performed using telemedicine services. In the managed care system, THSteps visits, well child check ups, and adult preventive visits will not be reimbursed if performed using telemedicine services. Care provided for abnormalities identified during these preventive health visits may be reimbursed if the care is provided by using telemedicine services.
Information about the diagnosis, evaluation, or treatment of a client with Medicaid coverage by a person licensed or certified to perform the diagnosis, evaluation, or treatment of drug abuse or any medical or emotional disorder is confidential information that the provider may disclose only to authorized people. Only the client may give written permission for release of any pertinent information before client information can be released, and confidentiality must be maintained in all other aspects. The signed consent form or documentation of consent for release of information is to become part of the medical records at the remote site.
Reimbursement for telemedicine services is made only when both the hub site provider and remote site provider are acceptable Medicaid provider types for telemedicine services.
Reimbursement for the telemedicine services is made only to the following Texas Medicaid Program enrolled primary care provider using the GT (telemedicine) modifier with the appropriate E/M code. RHCs and federally qualified health center (FQHC) providers must use encounter procedure codes with modifiers AM (physician), SA (APN/CNM), and U7 (PA) in addition to the GT modifier (refer to the following):
• Physicians (MDs/DOs).
•PA.
•NP.
•CNS.
•CNM.
Hub site providers are limited to:
•Physician (MD), provider type 20.
•Physician (DO), provider type 19.
Remote site providers are limited to:
•Physician (MD), provider type 20.
•Physician (DO), provider type 19.
•NP, CNS, PA, provider type 10.
•CNM, provider type 33.
•FQHC, provider type 46.
•RHC, provider types 78 and 79.
To provide Medicaid services, each NP, CNS, CNM, and CRNA must be licensed as a registered nurse and recognized as an APN by the Texas BON.
The Healthcare Common Procedure Coding System (HCPCS) modifier code GQ (through an asynchronous telecommunications system) is not appropriate for the Texas Medicaid telemedicine program and should not be used.
The remote and hub site providers are to be reimbursed for telemedicine services. Reimbursement for telemedicine services is made at current Texas Medicaid Reimbursement Methodology (TMRM) for CPT E/M codes and encounter rates for RHCs and FQHCs. Providers billing for teleradiology and telepathology services are to use the appropriate CPT code and the modifier GT.
The use of these modifiers by providers certifies they have met the criteria set forth by HHSC and that they understand claims data may be monitored for program integrity and provider compliance. Visits, consultations, and encounters are reimbursed based on individual policy guidelines; for example, global fee policy, consultation policy, and so forth (including payable provider types and POSs). Office or outpatient consultations are limited to one consultation per six-month period, same provider. All other consultations during the period are changed to the appropriate outpatient or office E/M code.
Telemedicine services are reimbursable only in the following POSs:
•Practitioner's office (Hub site).
•Practitioner's office (Remote site).
•RHC.
•FQHC.
•Inpatient hospital.
•Outpatient hospital.
•Emergency room.
•ICF-MR state schools.
Nursing facilities, SNFs, and client homes are not approved POSs.
Use of telemedicine services in ICF-MR state schools is subject to policies established by HHSC and DADS.
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