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Claims for Telephone (Audio Only) Medical Services

Last updated on 5/18/2020

Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, precertification, 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 ensure continuity of care during the COVID-19 (coronavirus) response, Children with Special Health Care Needs (CSHCN) Services Program is authorizing providers to bill the following procedure codes for telephone (audio only) medical (physician-delivered) evaluation and management services delivered on March 20, 2020, through April 30, 2020.

Description of Services

Procedure Codes

Evaluation and Management (E/M)

99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215

Providers should continue to use the 95 modifier to indicate the occurrence of remote delivery.

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 a part of the subsequent office visit.

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

Providers can refer to the CSHCN Services Program Provider Manual, Chapter 38, "Telecommunication Services," for additional information about the CSHCN telemedicine services benefit.

For more information, call the TMHP-CSHCN Services Program Contact Center at 800-568-2413.