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Update to “Claims for Telephone (Audio-only) Behavioral Health Services”

Last updated on 1/20/2022

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.

This is an update to the article titled “Claims for Telephone (Audio-only) Behavioral Health Services,” which was posted on this website on March 20, 2020.

To help ensure continuity of care during the COVID-19 (coronavirus) response, the following Medicaid COVID-19 flexibilities have been extended through April 30, 2022, for reimbursement of the listed behavioral health services delivered by telephone (audio-only) and audio-visual means:

Description of Services

Procedure Codes

Psychiatric Diagnostic Evaluation

90791, 90792

Psychotherapy

90832, 90834, 90837, 90846, 90847, 90853

Peer Specialist Services

H0038

Substance Use Disorder Services

H0001, H0004, H0005

Mental Health Rehabilitation

H0034, H2011, H2014, H2017

Note: Procedure codes 90832, 90834, and 90837 are allowed through the audio-visual modality in existing policy, and procedure codes H0001, H0004, and H0005 are allowed through the audio-visual modality in interim guidance.

To indicate remote delivery, providers should continue to use the 95 modifier. The Texas Health and Human Services Commission (HHSC) is extending these flexibilities through April 30, 2022, because they include teleservices that are being analyzed in line with House Bill (H.B.) 4 (87th Legislature, Regular Session, 2019).

For telehealth services related to screening, brief intervention, and referral to treatment (SBIRT) services, refer to the article titled “HB4: Behavioral Health Services Delivered by Synchronous Audio-visual or Telephone (Audio-only) Interim Guidance.”

Behavioral Health In-person Services

Effective March 1, 2022, the following procedure codes will not be allowed for reimbursement by synchronous audio-visual or audio-only (telephone) technology:

Description of Service

Procedure Code

Mental Health Rehabilitation Services Day Program for Acute Needs

H2012

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

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