Skip to main content

HB4: Behavioral Health Services Delivered by Synchronous Audio-visual or Telephone (Audio-only) Interim Guidance

Last updated on 1/19/2022

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.

Effective February 1, 2022, the Texas Health and Human Services Commission (HHSC) has authorized providers to submit claims for reimbursement for the following behavioral health services delivered by the telemedicine or telehealth modalities specified below. This notice will serve as interim guidance until the policy is codified in the Texas Administrative Code (TAC) and future Texas Medicaid Provider Procedures Manual updates are finalized.

For information about the ongoing COVID-19 related guidance for behavioral health services other than those listed in this article, refer to the article titled “Update to ‘Claims for Telephone (Audio-only) Behavioral Health Services.’”

Note: To indicate remote delivery, providers must continue to use modifier 95.

Audio-visual Behavioral Health Modalities

Effective February 1, 2022, HHSC has authorized Medicaid providers to submit claims for reimbursement of the following services by synchronous audio-visual technology:

Description of Services

Procedure Codes

Screening, Brief Intervention and Referral to Treatment (SBIRT) Services

99408, G2011, H0049

Substance Use Disorder – Assessment and Counseling Services

H0001, H0004, H0005

Health and Behavior Assessment and Intervention (HBAI) Services

96156, 96158, 96159, 96164, 96165, 96167, 96168

Telephone (Audio-only) Behavioral Health Modalities

Effective February 1, 2022, HHSC has authorized Medicaid providers to submit claims for reimbursement of the following services by synchronous telephone (audio-only) technology:

Description of Services

Procedure Codes

Screening, Brief Intervention, and Referral to Treatment (SBIRT) Services

99408, G2011, H0049

Health and Behavior Assessment and Intervention (HBAI) Services

96156, 96158, 96159, 96164, 96165, 96167, 96168

For all the behavioral health services listed above, per standards of care, the service modality must be clinically appropriate, safe, and agreed to by the person receiving services or by the legally authorized representative (LAR). Providers must defer to the needs of the person receiving services, allowing the mode of service delivery to be accessible, person- and family-centered, and primarily driven by the person’s choice and not provider convenience.

HHSC encourages the use of synchronous audio-visual technology over telephone audio-only delivery of telemedicine and telehealth services whenever possible.

Providers can refer to the Texas Medicaid Provider Procedures Manual, Behavioral Health and Case Management Services Handbook and Children’s Services Handbook for additional information about Texas Medicaid behavioral health benefits. For more information about current telemedicine and telehealth benefits and services, providers can refer to the Telecommunication Services Handbook.

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