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Telemedicine and Telehealth Services for the HTW and HTW Plus Programs

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Effective September 1, 2022, benefit information for the Healthy Texas Women (HTW) program will be updated to identify services that will remain permanent benefits when delivered through telemedicine and telehealth.

Certain telemedicine and telehealth services may be provided for HTW and HTW Plus clients when clinically appropriate and safe, as determined by the provider, and agreed to by the client receiving services.

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 a telemedicine or telehealth service 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.

Whenever possible, HHSC encourages face-to-face interactions, such as an in-person visit or the use of synchronous audiovisual technology, instead of synchronous telephone (audio-only) technology for telemedicine and telehealth services. Therefore, providers must document in the client’s medical record the reasons that services were delivered by synchronous telephone (audio-only) technology.

Telemedicine and Telehealth Services for HTW

The following HTW services may be provided through telemedicine delivery using synchronous audiovisual and synchronous telephone (audio-only) (as noted with an asterisk) technologies:

Behavioral Health Procedure Codes

90791*

90792*

96156*

96158*

96159*

96167*

96168*

Evaluation and Management Procedure Codes

99202

99203

99204

99205

99211(*)

99212*

99213*

99214*

99215*

99241

99242

99243

99244

99417

Q3014

           

Evaluation and management procedure codes noted with an asterisk in the table above (excluding procedure code 99211) may be delivered by synchronous telephone (audio-only) technology only for psychiatric care.

Note: Procedure code 99211 may be delivered by synchronous telephone (audio-only) technology for established clients only during certain public health emergencies (PHEs) or natural disasters.

For the diagnosis, evaluation, and treatment of a mental health or substance use condition only, established patient services (procedure codes 99211, 99212, 99213, 99214, and 99215) may be provided by synchronous telephone (audio-only) technology when clinically appropriate and safe (as determined by the provider) and agreed to by the client receiving services.

The following HTW psychiatric diagnostic evaluation services may be provided through telehealth delivery using synchronous audiovisual and synchronous telephone (audio-only) technologies:

Behavioral Health Procedure Codes

90791

90792

         

The following HTW distant-site services may be provided by federally qualified health centers (FQHCs) and rural health clinics (RHCs) through telemedicine and telehealth delivery using synchronous audiovisual technology:

Procedure Codes

G0466

G0467

G0468

G0469

G0470

T1015

 

Facility Fee for Telemedicine Patient Site Services

Effective for dates of service on or after September 1, 2022, the patient site facility fee (procedure code Q3014) will be a benefit of the HTW Program.

FQHCs and RHCs rendering telemedicine services as patient sites may be reimbursed the facility fee (procedure code Q3014) as an add-on procedure code that should not be included in any cost reporting that is used to calculate an FQHC Prospective Payment System (PPS), Alternative Prospective Payment System (APPS), or RHC All Inclusive Rate (AIR) PPS per visit encounter rate.

Telemedicine and Telehealth Services for HTW Plus Benefits

The following HTW Plus services may be provided using synchronous audiovisual and synchronous telephone (audio-only) (as noted with an asterisk) technologies:

Behavioral Health Procedure Codes

90832*

90833*

90834*

90836*

90837*

90838*

90847*

90853*

96130

96131

96136

96137

99354*

99355*

H0038*

           

Substance Use Disorder Procedure Codes

99408*

H0001(*)

H0004*

H0005*

H0049*

   

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

The following HTW Plus distant-site services may be provided by FQHCs and RHCs through telemedicine and telehealth delivery using synchronous audiovisual technology:

Procedure Codes

G0466

G0467

G0468

G0469

G0470

T1015

 

Modifier Requirements

Telemedicine and telehealth services delivered using synchronous audiovisual technologies 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.

Behavioral health services delivered using synchronous telephone (audio-only) technologies must be billed with modifier FQ.

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.

Additional documentation requirements apply for certain behavioral health services delivered by synchronous audiovisual technology and synchronous telephone (audio-only) technology.

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