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43.4.3.5 Face-to-Face Services
General Requirements for Face-to-Face Clinician-Directed Care Coordination Services
Providers must use the most appropriate face-to-face E/M procedure codes to bill for care coordination services.
• When counseling or care coordination requires more than 50 percent of the client and/or family encounter (face-to-face time in the office or other outpatient setting, or floor/unit time in the hospital), then time may be considered the key or controlling factor to qualifying for a particular level of E/M service.
•Counseling is discussion with the client and/or family concerning diagnostic studies or results, prognosis, risks and benefits, management options, importance of adhering to the treatment regimen, and client and family education.
Modifiers must be used as appropriate for billing.
Any face-to-face inpatient or outpatient E/M procedure code that is a benefit of the Texas Medicaid Program, except hospital discharge-day management (procedure codes 1-99238 and 1-99239) and discharge from observation (procedure code 1-99217), may be billed on the same day as the following non-face-to-face clinician-directed care coordination procedure codes when the procedure requires significant, separately-identifiable E/M services by the same physician on the same day.
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