Provider Alert! COVID-19 UPDATE ALERT #4 – Telemedicine Services – Physicians, BH, FQHC and RHC ProvidersTexas Children's Health Plan
Date: February 10, 2023
Attention: All providers
Effective Date: January 30, 2023
The content in this message on Federally Qualified Health Centers (FQHC) reimbursement for Telemedicine (Physician Delivered) and Telehealth (Non-Physician Delivered) Services as a distant site provider as permanent policy change (per S.B. 670, Texas Legislature, Regular session 2019) ended November 30, 2020 as announced by the Health and Human Services Commission. The content in this message on Rural Health Clinics as telehealth and telemedicine sites will remain in effect through March 31, 2022 as announced by the Health and Human Services Commission.
TCHP COVID-19 Utilization Management Procedure and TCHP 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 #5 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 April 30, 2023: 99201-99205 and 99211-99215
Behavioral Health Services- claims for telephone (audio-only) services permitted through May 31, 2022:
- 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
- Mental Health Rehabilitation: H0034, H2011, H2012, H2014, H2017
The COVID-19 flexibility to allow audio-only delivery of Substance Use Disorder – Assessment and Counseling Services: H0001, H0004, H0005 will end effective May 31, 2022. 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:
|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.
Effective May 1, 2022, through April 30, 2022, HHSC authorizes Medicaid FFS providers to submit claims for reimbursement of the following services delivered by synchronous audio-visual and telephone (audio-only) technology:
|Description of Service||Procedure Codes|
|Psychiatric Diagnostic Evaluation||90791, 90792|
|Psychotherapy||90832, 90834, 90837, 90846, 90847, 90853|
|Peer Specialist Services||H0038|
|Mental Health Rehabilitation||H0034, H2011, H2014, H2017|
|Mental Health Targeted Case Management (MHTCM) Services||T1017|
|Psychiatric Evaluation & Management (E/M) Services and Pharmacological Management||99202, 99203, 99204, 99205, 99211 ,99212, 99213, 99214, 99215|
6. Telemedicine provided by Rural Health Care Centers (RHC)
Ended March 31, 2022:
RHC providers performing patient-site telemedicine services may be reimbursed for the facility fee (procedure code Q3014) as an add-on procedure code.
Procedure code Q3014 will be a benefit for RHC providers when telemedicine services are rendered in the office or outpatient hospital setting.
More than one facility fee for the same client on the same date of service may be reimbursed for multiple distant-site provider consultations, when medically necessary.
If an RHC is eligible for payment of both an encounter fee and a telemedicine facility fee for the same client on the same date of service, the RHC must submit a claim for the facility fee separate from the claim submitted for the encounter. The facility fee should not be included in any cost reporting that is used to calculate the RHC All Inclusive Rate (AIR) prospective payment system (PPS) per visit encounter rate.
TCHP will reimburse RHCs as telemedicine (physician-delivered) service distant site providers effective immediately in an “Audio-visual” or “Audio Only” format. 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, (RHC – Section 7.2). To indicate that remote delivery occurred, RHCs should use the 95 modifier and Place of Service (POS) 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 RHC encounter billing. These codes may be used for Audio-visual or Audio only formats with appropriate documentation:
RHC Encounters: Procedure Codes T1015 and 99381- POS 02 and Modifier 95 must be placed on both the encounter (T1015) service line as well as the procedure code service line(s) to indicate use of the telehealth or telemedicine modality. TCHP will accept POS72 as well. Please note that RHCs may provide telemedicine as distant site provider statewide for services dates from March 4, 2020 through May 31, 2022.
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 RHC provider is physically located in an office space at an RHC, they should bill National 72 (RHC).
Providers may also use (POS) 02 – telemedicine services.
Effective January 1, 2022, POS Code 10 is available for providers who provide telehealth services to patients who attend the telehealth appointments in their own homes. Providers should continue to use POS code 02 when telehealth is provided and the patients attend the telehealth appointments anywhere other than their own homes (e.g., a hospital or skilled nursing facility).
7. 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 https://www.tmhp.com/sites/default/files/file-library/resources/provider-manuals/tmppm/pdf-chapters/2022/2022-11-november/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/
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.
If you have any questions, please email Provider Network Management at: email@example.com.
For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.