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WARNING: THIS IS A TEXAS HEALTH AND HUMAN SERVICES INFORMATION RESOURCES SYSTEM THAT CONTAINS STATE AND/OR U.S. GOVERNMENT INFORMATION. BY USING THIS SYSTEM YOU ACKNOWLEDGE AND AGREE THAT YOU HAVE NO RIGHT OF PRIVACY IN CONNECTION WITH YOUR USE OF THE SYSTEM OR YOUR ACCESS TO THE INFORMATION CONTAINED WITHIN IT. BY ACCESSING AND USING THIS SYSTEM YOU ARE CONSENTING TO THE MONITORING OF YOUR USE OF THE SYSTEM, AND TO SECURITY ASSESSMENT AND AUDITING ACTIVITIES THAT MAY BE USED FOR LAW ENFORCEMENT OR OTHER LEGALLY PERMISSIBLE PURPOSES. ANY UNAUTHORIZED USE OR ACCESS, OR ANY UNAUTHORIZED ATTEMPTS TO USE OR ACCESS, THIS SYSTEM MAY SUBJECT YOU TO DISCIPLINARY ACTION, SANCTIONS, CIVIL PENALTIES, OR CRIMINAL PROSECUTION TO THE EXTENT PERMITTED UNDER APPLICABLE LAW.
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AMA/ADA End User License Agreement
LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT® ")

You, your employees and agents are authorized to use CPT only as contained in materials on the Texas Medicaid & Healthcare Partnership (TMHP) website solely for your own personal use in directly participating in healthcare programs administered by THHS. You acknowledge that AMA holds all copyright, trademark and other rights in CPT.

Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to use CPT for any use not authorized herein must be obtained through the American Medical Association, Intellectual Property Services, 515 N. State Street, Chicago, Illinois, 60610. Applications are available at the American Medical Association website, www.ama-assn.org/go/cpt.

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This product includes CPT which is commercial technical data and/or computer databases and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer databases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (November 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements.

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1. Subject to the terms and conditions contained in this Agreement, you, your employees and agents are authorized to use CDT only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. Use of CDT is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. You acknowledge that the ADA holds all copyright, trademark and other rights in CDT. You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights included in the materials.

2. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CDT for resale and/or license, transferring copies of CDT to any party not bound by this agreement, creating any modified or derivative work of CDT, or making any commercial use of CDT. License to use CDT for any use not authorized herein must be obtained through the American Dental Association, 211 East Chicago Avenue, Chicago IL 60611. Applications are available at the American Dental Association web site, http://www.ADA.org.

3. U.S. GOVERNMENT RIGHTS. Applicable Federal Acquisition Regulation Clauses (FARS)\Department of Defense Federal Acquisition Regulation Supplement (DFARS) Restrictions Apply to Government Use. This product includes CDT, which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable, which was developed exclusively at private expense by the American Dental Association, 211 East Chicago Avenue, Chicago Illinois, 60611. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal Procurements.

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HB4: Behavioral Health Services Delivered by Telemedicine or Telehealth Effective September 1, 2022

Last updated on 7/18/2022

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 September 1, 2022, some behavioral health services delivered by synchronous audiovisual or synchronous telephone (audio-only) technology will become benefits of Texas Medicaid.

General Information

Providers of behavioral health services must defer to the needs of the person receiving services, allowing the mode of service delivery to be accessible, person- and family-centered, and driven primarily by the person’s choice and not provider convenience.

Providers of behavioral health services must provide services to Medicaid-eligible persons in accordance with accepted medical community standards and standards that govern occupations, as explained in Title 1 Texas Administrative Code (TAC) §371.1659. In addition, providers must deliver services, to include delivery by telemedicine or telehealth, in full accordance with all applicable licensure and certification and regulatory requirements.

During a declaration of a state of disaster, HHSC may issue direction to providers regarding the use of telemedicine or telehealth services to include the use of a synchronous telephone (audio-only) platform to provide covered services outside the allowances described herein to the extent permitted by Texas law. A declaration of a state of disaster occurs when an executive order or proclamation by the governor declaring a state of disaster is issued in accordance with Section 418.014 of the Texas Government Code.

Synchronous Audiovisual Technology

The following behavioral health services may be provided by synchronous audiovisual technology if clinically appropriate and safe, as determined by the provider, and agreed to by the person receiving the services. Services provided by synchronous audiovisual technology must be billed using modifier 95.

Description of Services	Procedure Codes
Health and Behavior Assessment and Intervention (HBAI) Services	96156, 96158, 96159, 96164, 96165, 96167, 96168
Mental Health Rehabilitation (MHR) Services	H0034, H2011, H2014, H2017
Mental Health Targeted Case Management (MHTCM) Services	T1017
Neurobehavioral Testing Services	96116, 96121
Neuropsychological Testing Services	96132, 96133, 96136, 96137
Peer Specialist Services	H0038
Physician Evaluation and Management (E/M) Services and Pharmacological Management Services	99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215
Psychiatric Diagnostic Evaluation Services	90791, 90792
Psychological Testing Services	96130, 96131, 96136, 96137
Psychotherapy Services	90832, 90833, 90834, 90836, 90837, 90838, 90846, 90847, 90853, 99354, 99355
Screening, Brief Intervention, Referral to Treatment (SBIRT) Services	99408, G2011, H0049
Substance Use Disorder (SUD) Services	H0001, H0004, H0005

Note: Pharmacological management services may be delivered by synchronous audiovisual technology for psychiatric care only. Providers must use the most appropriate E/M procedure code with modifier UD to designate when a visit is focused primarily on pharmacological management.

Note: Approval to deliver MHTCM, MHR (excluding crisis intervention services, procedure code H2011), and peer specialist services by synchronous audiovisual technology must be documented in the plan of care for the person receiving services.

Note: Neuropsychological and psychological testing services (procedure codes 96130, 96131, 96132, 96133, 96136, and 96137) may be delivered by synchronous audiovisual technology if the psychometric test is available in an online format (except for tests that are administered and responded to orally); the provider, or test administrator, observes the person in real time for the duration of the test; and the provider delivers the psychometric test in accordance with their licensing board and professional guidelines.

Synchronous Telephone (Audio-Only) Technology

Whenever possible, the Texas Health and Human Services Commission (HHSC) encourages face-to-face interaction, such as an in-person visit, as well as the use of synchronous audiovisual technology over synchronous telephone (audio-only) technology for telemedicine and telehealth services. Therefore, providers must document in the person’s medical record the reasons that services were delivered by synchronous telephone (audio-only) technology.

The following behavioral health services may be provided by synchronous telephone (audio-only) technology if clinically appropriate and safe, as determined by the provider, and agreed to by the person receiving the services. Services provided by synchronous telephone (audio-only) technology must be billed using modifier FQ.

Description of Services	Procedure Codes
Health and Behavior Assessment and Intervention (HBAI) Services	96156, 96158, 96159, 96164, 96165, 96167, 96168
Physician Evaluation and Management (E/M) Services and Pharmacological Management Services	99211, 99212, 99213, 99214, 99215
Screening, Brief Intervention, Referral to Treatment (SBIRT) Services	99408, G2011, H0049

Note: Pharmacological management services may be delivered by synchronous telephone (audio-only) technology for psychiatric care only. Providers must use the most appropriate E/M procedure code with modifier UD to indicate when a visit is focused primarily on pharmacological management.

Note: Physician E/M services may be provided by synchronous telephone (audio-only) technology only for the diagnosis, evaluation, and treatment of a mental health or substance use condition. Procedure code 99211 may be provided by synchronous telephone (audio-only) technology only during certain public health emergencies.

The following behavioral health services may be provided by synchronous telephone (audio-only) technology only to persons with whom the treating provider has an “existing clinical relationship” and if they are clinically appropriate and safe, as determined by the provider, and agreed to by the person receiving services. Services provided by synchronous telephone (audio-only) technology must be billed using modifier FQ:

Description of Services	Procedure Codes
Mental Health Rehabilitation (MHR) Services	H0034, H2011, H2014, H2017
Mental Health Targeted Case Management (MHTCM) Services	T1017
Peer Specialist Services	H0038
Psychiatric Diagnostic Evaluation Services	90791, 90792
Psychotherapy Services	90832, 90833, 90834, 90836, 90837, 90838, 90846, 90847, 90853, 99354, 99355
Substance Use Disorder (SUD) Services	H0001, H0004, H0005

An “existing clinical relationship” occurs when a person has received at least one in-person or synchronous audiovisual MHTCM, MHR, peer specialist, psychiatric diagnostic evaluation, psychotherapy, or SUD service (as applicable) from the same provider within the six months prior to the initial service delivered by synchronous telephone (audio-only) technology. The six-month requirement for at least one in-person or synchronous audiovisual service prior to the initial synchronous telephone (audio-only) service may not be waived.

The provider must conduct at least one in-person or synchronous audiovisual MHTCM, MHR, peer specialist, psychiatric diagnostic evaluation, psychotherapy, or SUD service (as applicable) every rolling 12 months from the date of the initial service delivered by synchronous telephone (audio-only) technology unless the person receiving the services and the provider agree that an in-person or synchronous audiovisual service is clinically contraindicated or the risks or burdens of an in-person or synchronous audiovisual service outweigh the benefits. The decision to waive the 12-month requirement applies to that particular rolling 12-month period, and the basis of the decision must be documented in the person’s medical record. Examples of when a synchronous telephone (audio-only) service may be more clinically appropriate or beneficial than an in-person or synchronous audiovisual service include but are not limited to the following:

The person receiving services is located at a qualifying originating site in an eligible geographic area (for example, a practitioner office in a rural Health Professional Shortage Area).
An in-person or synchronous audiovisual service is likely to cause disruption in service delivery or has the potential to worsen the person’s conditions.

Note: Approval to deliver MHTCM, MHR (excluding crisis intervention services, procedure code H2011), and peer specialist services by synchronous telephone (audio-only) technology must be documented in the plan of care for the person receiving services.

Note: Synchronous telephone (audio-only) technology may be used for crisis intervention services (procedure code H2011) only as a backup mode of delivery, meaning that the person who is in crisis, not the treating provider, is unwilling or has limited technological capabilities that prevent them from using a synchronous audiovisual platform at the time that they receive services. The “existing clinical relationship” requirement is waived, and documented approval in the person’s plan of care is not required prior to the delivery of crisis intervention services. However, providers must document the justification for using synchronous telephone (audio-only) technology to deliver crisis intervention services in the person’s medical record.

Note: The SUD comprehensive assessment (procedure code H0001) may be delivered by synchronous telephone (audio-only) technology only during certain public health emergencies or natural disasters and to the extent allowed by federal law (assessments for withdrawal management services are excluded). The “existing clinical relationship” requirement is waived.

Documentation Requirements

Documentation requirements for a telemedicine or telehealth service are the same as for an in-person visit and must accurately reflect the services rendered. Documentation must identify the means of delivery when provided by telemedicine or telehealth.

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