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Healthy Texas Women Claims for Telemedicine (Physician-delivered) and Telephone (Audio-only) Services COVID-19 Guidance Extended to October 31, 2022

Last updated on 9/30/2022

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 March 1, 2020, through October 31, 2022, to help ensure continuity of care during the COVID-19 response, the Texas Health and Human Services Commission (HHSC) is authorizing Healthy Texas Women (HTW) providers to bill the following procedure codes with modifier 95 for medical (physician-delivered) evaluation and management services delivered by telephone (audio-only):

Description of Services

Procedure Codes

Evaluation and Management (E/M)

90791, 90792, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215

Note: Providers should use modifier 95 to indicate that remote delivery has occurred.

Telephonic evaluation and management services must not be billed if it is determined that an in-person or telemedicine (audio-visual) office visit is needed within 24 hours or at the next available appointment. In those cases, the telephone (audio-only) service will be considered part of a subsequent office visit.

If the telephone call follows an office visit performed and reported within the past seven calendar days for the same diagnosis, the telephone services are considered part of the previous office visit and are not billed separately.

As a reminder, effective February 1, 2022, all HTW service procedure codes included in the Texas Medicaid Provider Procedures Manual, Telecommunication Services Handbook will be made permanent for HTW reimbursement when delivered through synchronous audiovisual telemedicine or telehealth. 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.