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Update to Family Planning Program Claims for Telemedicine (Physician-Delivered) and Telehealth (Non-Physician-Delivered) Services

Last updated on 5/9/2022

Effective for dates of service on or after May 1, 2022, the Family Planning Program (FPP) is authorizing providers to continue to bill the following codes for physician-delivered telephonic (audio only) medical evaluation and management services:

Description of Services Procedure Codes
Evaluation and Management (E/M) 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215

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

Telephonic medical 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 telephonic service will be considered a part of the subsequent office visit.

If the telephone call follows an office visit performed and reported within the previous 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 Texas Medicaid Provider Procedures Manual, Telecommunication Services Handbook for additional information about the Texas Medicaid telemedicine services benefit.

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