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COVID-19 Guidance for Telephone (Audio-Only) Medical Services Will End with the End of the PHE

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Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to Medicaid members who are enrolled in their MCO. Administrative procedures, such as prior authorization, precertification, referrals, and claims and encounter data filing, may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the member’s specific MCO for details.

Effective with the end of the federal public health emergency (PHE) on May 11, 2023, the Texas Health and Human Services Commission (HHSC) will end the temporary flexibility that has allowed for telephone (audio-only) medical (physician-delivered) evaluation and management (E/M) services.

In addition, HHSC issued interim guidance in the article titled “HB4: Non-Behavioral Health Audio-only Medical Office Visits Interim Guidance” that will take effect May 12, 2023, to allow some audio-only services to continue beyond the PHE.

To help ensure continuity of care during the COVID-19 (coronavirus) response from March 20, 2020, through May 11, 2023, HHSC authorized providers to bill the following procedure codes with modifier 95 for medical (physician-delivered) evaluation and management (E/M) services delivered by telephone (audio-only):

Description of Services

Description of Services

Evaluation and management (E/M)

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

Note: Providers should continue to use modifier 95 to indicate remote delivery through May 11, 2023.

Telephonic E/M services must not be billed if it is determined that an in-person or telemedicine (audiovisual) 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, 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.