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HTW and HTW Plus Telemedicine and Telehealth Services Interim Guidance

Last updated on 4/29/2022

This notice serves as interim guidance between May 1, 2022, and August 31, 2022, as the Texas Health and Human Services Commission (HHSC) is working to update the Texas Medicaid Provider Procedures Manual (TMPPM). The TMPPM update will provide additional benefit requirements and restrictions. The draft benefit language will be posted for public comment before it is finalized and made effective on September 1, 2022.

HTW Federally Qualified Health Center (FQHC) and Rural Health Clinic (RHC) Distant-Site Telemedicine and Telehealth Services

Effective for dates of service May 1, 2022, through August 31, 2022, as allowed in response to the COVID-19 (coronavirus) public health emergency, HHSC authorizes distant-site telemedicine and telehealth services provided by federally qualified health center (FQHC) and rural health clinic (RHC) providers for Healthy Texas Women (HTW) clients when submitted with procedure code T1015. 

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

Note: Telemedicine and telehealth services must be billed with modifier 95. Procedure codes that indicate remote delivery (telemedicine medical services or telehealth services) in the description do not need to be billed with modifier 95.

HTW Plus Behavioral Health Telemedicine and Telehealth Services

Effective for dates of service May 1, 2022, through August 31, 2022, HHSC has also authorized providers to submit HTW Plus claims for reimbursement for behavioral health services delivered by the telemedicine or telehealth modalities specified below.

Audio-visual Behavioral Health Modality

Effective for dates of service May 1, 2022, through August 31, 2022, HHSC has authorized providers to submit claims for reimbursement of the following HTW Plus services delivered by synchronous audio-visual technology:

Description of Services

Procedure Codes

Substance Use Disorder – Assessment and Counseling Services

H0001, H0004, H0005

Audio-visual and Telephone (Audio-only) Behavioral Health Modalities

Effective for dates of service May 1, 2022, through August 31, 2022, HHSC has authorized providers to submit claims for reimbursement of the following HTW Plus services delivered by synchronous audio-visual and telephone (audio-only) technology:

Description of Services

Procedure Codes

Psychotherapy

90832, 90834, 90837, 90847, 90853

Peer Specialist Services

H0038

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

99408, H0049

Note: Telemedicine and telehealth services must be billed with modifier 95. 

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 recipient’s 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.

Whenever possible, HHSC encourages face-to-face interaction, such as in-person visits or synchronous audio-visual technology, over telephone (audio-only) technology for telemedicine and telehealth services.

Providers can refer to the TMPPM Healthy Texas Women Program Handbook for additional information about HTW Plus benefits. For more information about current telemedicine and telehealth benefits and services, providers can refer to the Telecommunication Services Handbook and the article titled “Update to HB4: Behavioral Health Services Delivered by Synchronous Audio-visual or Telephone (Audio-only) Interim Guidance.”

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