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 for dates of service on or after November 1, 2023, telemedicine and telehealth benefit information will be updated for Texas Medicaid.
Overview of Updates
Updates to benefit information include the following:
- The implementation of a new telehealth patient site facility fee benefit for federally qualified health center (FQHC) and rural health clinic (RHC) providers
- Clarification of current guidelines
Telehealth Patient Site Facility Fee
The facility fee (procedure code Q3014) for telehealth services will be a benefit for patient site FQHC and RHC providers that are enrolled in Texas Medicaid. It will not be a benefit if the patient site is in the client’s home.
Procedure code Q3014 may be reimbursed as follows:
- To FQHCs as an add-on procedure code that should not be included in any cost reporting that is used to calculate a Prospective Payment System (PPS) or Alternative Prospective Payment System (APPS) per visit encounter rate
- To RHCs as an add-on procedure code that should not be included in any cost reporting that is used to calculate the RHC AIR (All Inclusive Rate) PPS per visit encounter rate
To receive reimbursement for more than one facility fee for the same client on the same date of service, an FQHC or RHC must submit documentation of medical necessity that the client needed multiple distant-site provider consultations. An FQHC or RHC can use a signed letter from the client’s treating health care provider at the FQHC or RHC to document the client’s medical need to receive additional facility fee payments for the same client on the same date of service. The letter must state that the client suffered an illness or injury that required additional diagnosis or treatment by a distant-site provider.
If an FQHC or RHC is eligible for the payment of both an encounter fee and a facility fee for the same client on the same date of service, the FQHC or RHC must submit a claim for the facility fee separate from the claim that was submitted for the encounter.
Charges for other services that are performed at the patient site may be submitted separately.
Clarifications for Telemedicine and Telehealth
FQHC practitioners may be employees of the FQHC or contracted with the FQHC. RHC practitioners may be employees of the RHC or contracted with the RHC.
A distant-site provider that is located outside of state lines while rendering services is considered an out-of-state provider.
For more information, call the TMHP Contact Center at 800-925-9126.