Provider Alert! Update to Clarify Delivery of Certain Behavioral Health Services through Synchronous Audiovisual or Synchronous Telephone (Audio-Only) Technology

Date: February 16, 2024

Attention: Behavioral Health Providers

Effective date: December 1, 2023

Call to action: The purpose of this communication is to provide further information about the October 26 Provider Alert.  This alert provides updates to some of the behavioral health Medicaid benefits and to clarify the delivery of those services through synchronous audiovisual or synchronous telephone (audio-only) technology that are effective December 1, 2023.

Texas Children’s Health Plan (TCHP) follows the limitations and requirements for the corresponding behavioral health codes outlined by the Texas Medicaid and Healthcare Partnership (TMHP) in the Texas Medicaid Provider Procedures Manual, Behavioral health and Case Management Services Handbook.

How this impacts providers: Texas Children’s Health Plan would like to highlight the following points about audio-only services:  

• Audio-only services are a benefit for the delivery of specific mental health services including but not limited to outpatient mental health targeted case management (MHTCM), mental health rehabilitative (MHR), peer specialist, and substance use disorder (SUD) services and must be billed with modifier FQ.
• Face-to-face interaction, such as an in-person visit, as well as the use of synchronous audiovisual technology over synchronous telephone (audio-only) is encouraged.  If audio-only services are provided, the provider must document in the medical record the reason(s) why audio-only was used.
• The billing provider is required to conduct at least one in-person or synchronous audiovisual MHR, MHTCM, or peer specialist service every rolling 12 months from the date of the initial service delivered by audio-only technology (see TMPPM for details).
• Texas Children’s Health plan reserves the right to conduct an audit of the medical records to confirm compliance with visit requirements, correct billing practices, or other education needs.

Resources are as follows:

• Information about outpatient mental health, MHTCM, MHR, peer specialist and substance use disorder (SUD) services is published in Behavioral Health and Case Management Services Handbook (Vol. 2, Provider Handbooks) in the TMPPM.
• TMHP bulletin: TMPPM Update to Clarify Delivery of Certain Behavioral Health Services Through Synchronous Audiovisual or Synchronous Telephone (Audio-Only) Technology published on October 13, 2023.
• TMHP bulletin: HB4: Behavioral Health Services Delivered by Telemedicine or Telehealth Effective September 1, 2022 published on July 15, 2022.

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

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