Provider Alert! Benefits for Telemedicine Services and Telehealth Services to Change for Texas Medicaid December 1, 2020

Attention: FQHCs and  School-based Clinics

Effective Date: For dates of service on or after December 1, 2020

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 (TCHP) aligns with the changes to telemedicine (physician-delivered) services and telehealth (non-physician delivered) services include reimbursing federally qualified health centers (FQHCs) for telemedicine and telehealth services, updated guidelines for school-based telemedicine services, and clarification of Texas Medicaid managed care organization guidelines for telemedicine services. Effective for dates of service on or after December 1, 2020, benefits for telemedicine services and telehealth will change for Texas Medicaid.
Source: TMHP MCO Notice

How this impacts providers: FQHCs may be reimbursed for telemedicine and telehealth services when services are provided in the office and outpatient settings.

FQHCs providing distant-site telemedicine and telehealth services may be reimbursed for the following procedure codes:

FQHCs may be reimbursed the distant-site provider fee for telemedicine and telehealth services at the Prospective Payment System (PPS) rate or Alternative Prospective Payment System (APPS) rate. Telemedicine and telehealth services should be billed using modifier 95.

FQHCs may be reimbursed the facility fee (procedure code Q3014) for telemedicine services. Procedure code Q3014 should be billed as an add-on procedure code, which should not be included in any cost reporting that is used to calculate a PPS or APPS 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 must provide the following:

• Submit documentation of medical necessity indicating that the client needed multiple distant-site provider consultations.
• A signed letter from the client’s treating health-care provider at the FQHC stating that the client suffered an illness or injury requiring additional diagnosis or treatment by a distant-site provider will be sufficient to document the client’s medical need for receiving multiple distant-site provider consultations on the same date of service.
• If an FQHC is eligible for payment of both an encounter and a facility fee for the same client on the same date of service, the FQHC must submit a claim for the facility fee separate from the claim submitted for the encounter.

School-Based Setting:

A health professional will no longer be required to be present with a client located in a school-based setting during a treatment delivered via telemedicine.

Next steps for providers: Impacted providers should inform their staff of the billing requirements outlined in this communication.

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.