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HB4: Interim Guidance for Non-Behavioral Health Audio-Only Medical Office Visits

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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.

The Texas Health and Human Services Commission (HHSC) has authorized changes to claims for reimbursement of services.

Effective May 12, 2023, providers may submit claims for reimbursement for telephone (audio-only) established patient office visits for non-behavioral health (non-BH) services specified in this article and per their licensing board and professional guidelines. Providers can refer to the Texas Medicaid Provider Procedures Manual (TMPPM), Behavioral Health and Case Management Services Handbook and Children’s Services Handbook, for additional information about Texas Medicaid behavioral health benefits that may be delivered through telephone (audio-only).

This article serves as interim guidance until the TMPPM is updated, which is expected to be December 1, 2023. The TMPPM update may provide additional benefit requirements and restrictions. The draft benefit language will be posted for public comment before it is finalized and made effective in alignment with Texas Administrative Code TAC 354.1436.

Note: To indicate audio-only remote delivery, providers should no longer use modifier 95 (audiovisual) and should use modifier 93 (audio-only).

Effective for dates of service May 12, 2023, through December 1, 2023, Medicaid providers may submit claims for reimbursement of the following non-BH services for established clients by synchronous telephone (audio-only) technology when appended with modifier 93. For information about behavioral health services that may be delivered by synchronous telephone (audio-only), refer to the TMPPM, Behavioral Health and Case Management Services Handbook and Children’s Services Handbook.

Description of Services

Procedure Codes

Established patient office visit

99212, 99213, 99214, 99215

Note: These procedure codes are allowed for synchronous audiovisual delivery as outlined in the TMPPM.

Modifier for Non-BH Audio-Only Telemedicine Services



Delivered by synchronous telephone (audio-only) technology

Note: For non-BH services, procedure code 99211 may not be delivered through synchronous telephone (audio-only) technology but may be delivered through synchronous audiovisual technology when appended with modifier 95.

For all the services listed above, providers must follow the standard of care requirements outlined in their licensing regulations. The service should only be delivered through synchronous telephone (audio-only) technology if:

  • The provider determines that it is clinically appropriate.
  • The client who is receiving the services or their legally authorized representative agrees.

Whenever possible, HHSC encourages face-to-face interaction, such as in-person visits or synchronous audiovisual technology, in place of telephone (audio-only) technology for telemedicine and telehealth services.

The service should only be provided by audio-only delivery as medically necessary and in alignment with Section 111.007 of the Texas Occupations Code.

For more information about current telemedicine and telehealth benefits and services, providers can refer to the Telecommunication Services Handbook in the TMPPM.

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