Skip to main content

HTW Benefit Information Will Be Updated on November 1, 2023

Last updated on

Effective for dates of service on or after November 1, 2023, Healthy Texas Women (HTW) benefit information will be updated to include the following:

  • Additional HTW services allowed through telephone (audio-only) technology
  • Reimbursement information for federally qualified health centers (FQHCs) and rural health clinics (RHCs)
  • Clarification for HTW Plus services

Telephone (Audio-Only) Services for HTW

The following telemedicine services for non-behavioral health conditions may be provided by synchronous telephone (audio-only) technology:

  • Established patient services (procedure codes 99212, 99213, 99214, and 99215)
  • Established patient service (procedure code 99211) — only during certain public health emergencies

The following procedure codes may be reimbursed to FQHCs and RHCs that provide telemedicine and telehealth services using synchronous telephone (audio-only) technology: G0466, G0467, G0468, G0469, G0470, and T1015.

Non-behavioral health services delivered using synchronous telephone (audio-only) technologies must be billed using modifier 93.

Services for behavioral health or substance use conditions that are delivered using synchronous telephone (audio-only) technologies must be billed using modifier FQ.

FQHC and RHC Reimbursement for Telemedicine and Telehealth HTW Services

FQHCs and RHCs may be reimbursed the distant-site provider fee for telemedicine and telehealth services at the prospective payment system (PPS) rate, alternative prospective payment system (APPS) rate, or all-inclusive rate (AIR) PPS.

FQHCs and RHCs may be reimbursed the patient-site facility fee for telehealth services (procedure code Q3014) as an add-on procedure code that should not be included in any cost reporting that is used to calculate an FQHC PPS or APPS or the RHC AIR PPS per visit encounter rate.

Clarification for HTW Plus Benefits

The enhanced postpartum services provided to eligible HTW clients through HTW Plus are in addition to all standard HTW benefits.

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