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Synchronous Audiovisual Telemedicine Delivery for Certain Physician Evaluation and Management Procedure Codes Effective September 1, 2022

Last updated on 7/15/2022

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 for dates of service on or after September 1, 2022, synchronous audiovisual technology telemedicine delivery for physician evaluation and management for general family planning, antenatal, and postnatal services may be a benefit of Texas Medicaid.

The following procedure codes may be reimbursed for telemedicine (physician-delivered) evaluation and management for general family planning, antenatal, and postnatal services delivered using synchronous audiovisual technology to new and established clients:

Procedure Codes











New and established patient evaluation and management services delivered through synchronous audiovisual technology must be billed with modifier 95.

When billing for prenatal and antenatal services, use modifier TH with the appropriate evaluation and management procedure code to the highest level of specificity.

A telemedicine service delivered through synchronous audiovisual technology may be used if:

  • The provider determines that the service is clinically appropriate (the provider can comply with the standard of care that would apply to the provision of the same service if delivered in person).
  • The provider determines that delivering the service through synchronous audiovisual technology is safe.
  • The provider delivers the telemedicine service in compliance with the requirements and limitations of telemedicine services (physician-delivered services) and the standards established by the licensing or certifying board of the provider delivering the service.

Documentation requirements for a telemedicine service are the same as for an in-person visit and must accurately reflect the services rendered. The documentation must identify the service delivery method used when provided through telemedicine.

Declaration of a State of Disaster

Under a declaration of a state of disaster, the Texas Health and Human Services Commission (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 is issued by the governor declaring a state of disaster in accordance with Section 418.014 of the Texas Government Code.

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