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Telehealth Services for the Early Childhood Intervention Program

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 September 1, 2022, benefit information for the Early Childhood Intervention (ECI) program will be updated to identify services that will remain permanent benefits when delivered through telehealth.

Reminder: Providers that perform ECI services must follow 26 Texas Administrative Code (TAC) Part 1, Chapter 350 in its entirety.

Guidelines for Telehealth Services

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

Services may be provided through telehealth delivery using synchronous audiovisual technology if all the following criteria are met:

  • The provider determines that the service is clinically appropriate and 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 using synchronous audiovisual technology is safe.
  • The provider delivers the telehealth service in compliance with the requirements and limitations identified in the current Texas Medicaid Provider Procedures Manual, Telecommunication Services Handbook and standards established by the respective licensing or certifying board of the provider delivering the service.
  • The provider receives written consent from the parent or caregiver for ECI services. For information about informed consent requirements for non-ECI services, providers may refer to the following handbooks in the current Texas Medicaid Provider Procedures Manual:
  • Behavioral Health and Case Management Services Handbook
  • Children’s Services Handbook
  • Physical Therapy, Occupational Therapy, and Speech Therapy Services Handbook
  • School Health and Related Services (SHARS) Handbook

Services delivered by a synchronous audiovisual platform will require participation of a parent or caregiver to assist with the treatment.

Services Allowed Using Telehealth Delivery

The following services may be provided through telehealth delivery using synchronous audiovisual technology:

Services

Procedure Codes

Specialized skills training (SST)

T1027

Targeted case management (TCM)

T1017

Physical therapy (PT) evaluations and reevaluations

97161, 97162, 97163, 97164

Occupational therapy (OT) evaluations and reevaluations

97165, 97166, 97167, 97168

PT and OT treatments

97110, 97112, 97150, 97530, 97535

Speech therapy (ST) evaluations and reevaluations

92521, 92522, 92523, 92524, 92610, S9152

ST treatments

92507, 92508, 92526

Therapy assistants may deliver services and receive supervision using synchronous audiovisual technology in accordance with each discipline’s rules. Providers should refer to state practice rules and national guidelines regarding supervision requirements for each discipline.

TCM services (procedure code T1017) may also be delivered through synchronous audio-only (including telephone) technology.

Claim and Documentation Requirements

Services delivered using synchronous audiovisual technology must be billed with modifier 95 to indicate remote delivery.

Reminder: Providers must also submit the required modifiers GP, GO, and GN on all physical, occupational, and speech therapy treatment claims.

TCM services delivered using synchronous audio-only (including telephone) technology must be billed with modifier 93.

Telehealth services must adhere to documentation, privacy, informed consent, and security requirements as outlined in this article and in the current Texas Medicaid Provider Procedures Manual, Telecommunication Services Handbook.

Telehealth Exclusions

The following procedure codes are in-person only and will not be reimbursed if provided through telehealth delivery:

Procedure Codes

97012

97014

97016

97018

97022

97024

97026

97028

97032

97033

97034

97035

97036

97113

97124

97140

97542

97760

97761

97763

 

Any PT, OT, ST, and SST services delivered through synchronous audio-only (including telephone) technology will not be a benefit.

Note: During a declaration of a state of disaster, the Texas Health and Human Services Commission (HHSC) may issue direction to providers regarding the use of a telemedicine or telehealth service to include the use of a synchronous audio-only (including telephone) platform to provide covered services outside the allowances described in this article. A declaration of a state of disaster is an executive order or proclamation 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.