Provider Alert! COVID-19 UPDATE ALERT #4 – Telemedicine Services – Physicians, BH, FQHC and RHC Providers

Provider Alert! COVID-19 UPDATE ALERT #4 – Telemedicine Services – Physicians, BH, FQHC and RHC Providers

Attention: All Providers
Effective Date: May 22, 2020

The content in this message will remain in effect throughout the COVID-19 Disaster Declaration period as announced by the office of the Texas Governor, Greg Abbott. COVID-19 Utilization Management Procedure and provider alerts can be found here: http://www.thecheckup.org/provider-alerts/

Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event.

Call to action: Texas Children’s Health Plan supports the delivery of telemedicine services to its members. Telemedicine services should be provided in compliance with standards established by the respective licensing or certifying board of the professional providing the service. Telemedicine services do not require authorization when provided by an in-network provider of any appropriate specialty.

  • Telemedicine acceptable visit formats during COVID-19
    As part of our COVID-19 Emergency Response, Texas Children’s Health Plan will add coverage of telemedicine services that are provided through synchronous “audio-visual” interactions and “audio-only” telephonic visits for a limited set of codes (see item #4 below).
  • Updated June 18, 2020: Texas Health Steps Telemedicine Guidance for Providers
    Visit the HHSC website for updates to the FAQs regarding the guidance permitting remote delivery of certain components of Texas Health Steps medical checkups.
  • Asynchronous Telemedicine

At this time, TCHP does not allow for “asynchronous” telemedicine visits.  Asynchronous visits are considered telemedicine visits where health information is forwarded electronically, stored, retrieved, reviewed and then responded to outside of a “real-time” interaction with the member patient.

  • Provider Reimbursement for Telemedicine services

TCHP will reimburse providers for appropriately billed Telemedicine services (see the Texas Provider Procedures Manual and Handbooks (TMPPMH)) at an equivalent rate of a face to face visit.

Copays applicable to the CHIP program are to be waived for Telemedicine services.

Out-of-network (OON) PCP (FP, IM, Pedi, OBG) designated specialties only may also provide Telemedicine services during the duration of the disaster declaration. All other OON providers must obtain prior authorization to provide care and services via telemedicine.

  • Procedure Codes for “Audio Only” telephonic interactions:
Procedure Codes allowable for “Audio Only” with appropriate documentation are:

Medical Services- claims for telephone (audio-only) services permitted through the disaster declaration period:  99201-99205 and 99211-99215

Behavioral Health Services- claims for telephone (audio-only) services permitted through the disaster declaration period:

·         Psychiatric Diagnostic Evaluation: 90791, 90792

·         Psychotherapy: 90832, 90834, 90837, 90846, 90847, 90853

·         Peer Specialist Services: H0038

·         Screening, Brief Intervention, and Referral to Treatment (SBIRT): H0049, G2011, 99408

·         Substance Use Disorder Services: H0001, H0004, H0005

·         Mental Health Rehabilitation: H0034, H2011, H2012, H2014, H2017

Behavioral Health Services with an effective date that is retrospective to March 20, 2020:

·         The following service codes are allowable via synchronous (audio/visual) telehealth interactions:

Codes Description
96130, 96131,96132,96133,96136,and 96137 Psychological testing is limited to eight hours per member, per calendar year. Additional hours require prior authorization when medically necessary.
96116 and 96121 Neurobehavioral testing is limited to four hours per member, per day and eight hours per member, per calendar year. These codes will not be paid for the same date of service to the same provider as psychological testing codes 96130, 96131, 96136, and 96137. The same applies to neuropsychological testing codes 96132,96133,96136, and 96137. The provider must maintain all documentation in the client’s medical record.

Be sure to bill with modifier 95 and the appropriate POS. The POS must reflect where the provider is located when delivering the service.

  • Telemedicine provided by Federally Qualified Health Centers (FQHC) & Rural Health Care Centers (RHC)

TCHP will reimburse FQHCs and RHCs as telemedicine (physician-delivered) service distant site providers effective immediately in an “Audio-visual” or “Audio Only” format. FQHCs and RHCs should bill for telemedicine services using the encounter and informational procedure codes outlined in the Texas Medicaid Provider Procedures Manual, Clinic and Other Outpatient Facility Services Handbook, (FQHC – Section 4.1.2 and RHC – Section 7.2). To indicate that remote delivery occurred, FQHCs and RHCs should use the 95 modifier and Place of Service 02 when submitting claims and encounters. The telemedicine service must also meet applicable state statutory and rule scope-of-practice requirements.

Texas Health and Human Services Commission (HHSC) acceptable coding for FQHC and RHC encounter billing.  These codes may be used for Audio-visual or Audio only formats with appropriate documentation:

FQHC Encounters: T1015

RHC Encounters: T1015 and 99381.  Please note that RHCs may provide telemedicine as distant site provider statewide for services dates from March 4, 2020 through the disaster declaration period.

For any telemedicine service billed, modifier 95 must be billed with the appropriate procedural CPT code(s) along with the POS that reflects where the provider is located when delivering the service. For example, if the FQHC/RHC provider is physically located in an office space at an FQHC/RHC, they should bill National POS 50 (FQHC) or 72 (RHC).

Providers may also use (POS) 02 – telemedicine services.

  • There are no other changes to the TCHP telemedicine services policy and procedure at this time.

Providers with existing authorizations do not need an additional authorization to provide the eligible service via telemedicine unless as stated above.

Texas Children’s Health Plan follows the Medical Policy for Telemedicine and Telehealth Services as written in the current Texas Medicaid Provider Procedures Manual – Telecommunication Services Handbook. Please reference http://www.tmhp.com/manuals_pdf/tmppm/tmppm_living_manual_current/2_Telecommunication_Srvs.pdf for additional information. Providers should verify that correct billing processes are in place including proper coding.

http://www.thecheckup.org/2020/03/18/provider-alert-update-telemedicine-telehealth-services-and-covid-19/

http://www.thecheckup.org/2020/03/31/provider-alert-update-alert-3-telehealth-services-ptotst-fqhcrhc-providers-and-covid-19/

Next steps for providers:

Providers are reminded to use appropriate coding as defined by Medicaid, or in the above specified guidance for billing of Telemedicine and Telehealth services. Effective April 10, 2020 for dates of service on or after April 1, 2020, diagnosis code U071 will be a benefit of Texas Medicaid and the Children with Special Health Care Needs Services Program for reporting COVID-19.

Providers can reference previously released Provider Alerts on this topic at the links provided below:

http://www.thecheckup.org/2020/03/20/provider-alert-anywhere-care-telemedicine-how-to-become-a-participating-provider/

If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.

For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.

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