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, certain telemedicine services for non-behavioral health conditions may be provided by synchronous telephone (audio-only) technology.
The following office and other outpatient telemedicine services may be provided by synchronous telephone (audio-only) technology for the diagnosis, evaluation, and treatment of non-behavioral health conditions if clinically appropriate and safe, as determined by the provider and agreed to by the client receiving services:
- Established patient services (procedure codes 99212, 99213, 99214, and 99215)
- Established patient service (procedure code 99211) – only during certain public health emergencies
Established patient services for non-behavioral health conditions provided by synchronous telephone (audio-only) technology must be billed using modifier 93.
Refer to the current Texas Medicaid Provider Procedures Manual, Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook, section 188.8.131.52, “Office or Other Outpatient Services by Telemedicine,” for more information about providing services through synchronous telephone (audio-only) technology.
For more information, call the TMHP Contact Center at 800-925-9126.