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

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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.