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Claims for Telephone (Audio-only) Medical Services COVID-19 Guidance Extended to November 30, 2022

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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.

To help ensure continuity of care during the COVID-19 (coronavirus) response, the Texas Health and Human Services Commission (HHSC) is authorizing providers to bill the following procedure codes for telephone (audio-only) medical (physician-delivered) evaluation and management services delivered from March 20, 2020, through November 30, 2022:

Description of Services

Procedure Codes

Evaluation and management (E/M)

99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215

Providers should continue to use modifier 95 to indicate remote delivery.

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

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

Providers can refer to the Texas Medicaid Provider Procedures Manual, Telecommunications Services Handbook for additional information about the Texas Medicaid telemedicine services benefit.

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