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Telephone (Audio-only) Delivery of Some Medicaid and HTW Plus Substance Use Services Ending

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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, 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 May 31, 2022, the Texas Health and Human Services Commission (HHSC) will end the temporary flexibility that has been allowed for behavioral health services described below. The following flexibility will no longer be allowed for dates of service beginning June 1, 2022.

To help ensure continuity of care during the COVID-19 (coronavirus) response, the following Medicaid COVID-19 flexibilities were implemented to allow for reimbursement of the following behavioral health services delivered by telephone (audio-only). This flexibility is allowed through May 31, 2022, and will end after that date.

Description of Services

Procedure Codes

Substance Use Disorder Services

H0001, H0004, H0005

Procedure codes H0001, H0004, and H0005 are allowed by audio-visual technology as described in the article titled “Update to HB4: Behavioral Health Services Delivered by Synchronous Audio-visual or Telephone (Audio-only) Interim Guidance”.

Note: To indicate the occurrence of remote delivery, providers should continue to use modifier 95.

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.