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RHC Reimbursement for Telemedicine and Telehealth Services

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Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, pre-certification, referrals, and claims/encounter data filing may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the client's specific MCO for details.

To help rural health clinics (RHCs) deliver care to clients in response to COVID-19 (coronavirus), RHCs may be reimbursed as telemedicine and telehealth distant site providers statewide for service dates from March 24, 2020, through April 30, 2020.

RHCs should use the modifier 95 on claims to indicate use of the telehealth or telemedicine modality.

Providers can refer to the Texas Medicaid Provider Procedures Manual, Telecommunication Services Handbook and the Clinics and Other Outpatient Facility Services Handbook for more information about the Texas Medicaid telemedicine and RHC service benefits.

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