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WARNING: THIS IS A TEXAS HEALTH AND HUMAN SERVICES INFORMATION RESOURCES SYSTEM THAT CONTAINS STATE AND/OR U.S. GOVERNMENT INFORMATION. BY USING THIS SYSTEM YOU ACKNOWLEDGE AND AGREE THAT YOU HAVE NO RIGHT OF PRIVACY IN CONNECTION WITH YOUR USE OF THE SYSTEM OR YOUR ACCESS TO THE INFORMATION CONTAINED WITHIN IT. BY ACCESSING AND USING THIS SYSTEM YOU ARE CONSENTING TO THE MONITORING OF YOUR USE OF THE SYSTEM, AND TO SECURITY ASSESSMENT AND AUDITING ACTIVITIES THAT MAY BE USED FOR LAW ENFORCEMENT OR OTHER LEGALLY PERMISSIBLE PURPOSES. ANY UNAUTHORIZED USE OR ACCESS, OR ANY UNAUTHORIZED ATTEMPTS TO USE OR ACCESS, THIS SYSTEM MAY SUBJECT YOU TO DISCIPLINARY ACTION, SANCTIONS, CIVIL PENALTIES, OR CRIMINAL PROSECUTION TO THE EXTENT PERMITTED UNDER APPLICABLE LAW.
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AMA/ADA End User License Agreement
LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT® ")

You, your employees and agents are authorized to use CPT only as contained in materials on the Texas Medicaid & Healthcare Partnership (TMHP) website solely for your own personal use in directly participating in healthcare programs administered by THHS. You acknowledge that AMA holds all copyright, trademark and other rights in CPT.

Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to use CPT for any use not authorized herein must be obtained through the American Medical Association, Intellectual Property Services, 515 N. State Street, Chicago, Illinois, 60610. Applications are available at the American Medical Association website, www.ama-assn.org/go/cpt.

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This product includes CPT which is commercial technical data and/or computer databases and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer databases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (November 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements.

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Healthy Texas Women and Family Planning Program Claims for Telemedicine (Physician Delivered) and Telephone (Audio Only) Services

Last updated on 6/30/2022

This article has been updated. To view the updated information, click here.

Information posted March 25, 2020

To help ensure continuity of care during the COVID-19 (coronavirus) response, effective March 1, 2020 the following procedure codes, when billed with the 95 modifier, will be a benefit for distant-site telemedicine and telehealth providers in Healthy Texas Women (HTW) and Family Planning Program (FPP) through April 30, 2020:

Description of Services	Procedure Codes
Evaluation and Management (E/M)	99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 90791, and 90972

Providers may bill retroactively for telemedicine or telehealth services provided on or after March 1, 2020.

HHSC is authorizing HTW and FPP providers to bill the procedure codes listed above for telephone (audio-only) medical (physician delivered) evaluation and management services delivered on March 20, 2020 through April 30, 2020. Providers should use the 95 modifier to indicate that remote delivery has occurred.

Telephonic evaluation and management services must not be billed if it is determined that an in-person or telemedicine (video) office visit is needed within 24 hours or at the next available appointment. In those cases, the telephone service will be considered part of a subsequent office visit.

If the telephone call follows an office visit performed and reported within the past seven calendar days for the same diagnosis, the telephone services are considered part of the previous office visit and are not billed separately.

Providers can refer to the Texas Medicaid Provider Procedures Manual, Telecommunication Services Handbook for additional information about the Texas Medicaid telemedicine services benefit.

For more information, call the TMHP Contact Center at 800-925-9126.