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36.3.7.2 Remote Site Provider
Remote site providers must be primary care providers, such as physicians, PAs, NPs, CNSs, or CNMs, who provide visits/encounters in their offices, RHCs, or FQHCs and are able to bill the Texas Medicaid Program independently. Remote site providers must be located in rural or underserved areas. The remote site provider is responsible for carrying out or coordinating the plan of care and treatment after consulting with the hub site provider. Because the office visit or encounter must be through interactive video, the remote site provider must be present with the client during the performance of the interactive video telemedicine consultation. The signed consent form or documentation of consent for release of information must remain in the medical records at the remote site.
Remote site providers may be reimbursed for an office visit (POS 1) using procedure codes 1-99201, 1-99202, 1-99203, 1-99204, 1-99205, 1-99211, 1-99212, 1-99213, 1-99214, and 1-99215 or encounter code 1-T1015 (FQHC, RHC) in POS 1 or 5, as applicable.
FQHC and RHC telemedicine encounter providers must submit their claims using the following modifiers. Use modifier AM, U7, or SA in the first modifier field on the claim form together with the modifier GT in the second field on the claim form.
If a prolonged physician service (procedure codes 1-99354 and 1-99355) or a special service (procedure code 1-99050) is provided in addition to a telemedicine office visit (procedure codes 1-99201, 1-99202, 1-99203, 1-99204, 1-99205, 1-99211, 1-99212, 1-99213, 1-99214, and 1-99215), these services should also be billed with modifier GT.
Telemedicine services are not a benefit when provided in nursing homes, SNFs, or the client's home.
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