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UPDATED: HHS Notice: Claims for Telephonic Behavioral Health and Medical Services

Date: 03/25/21

To help ensure continuity of care during the COVID-19 (coronavirus) response, Texas Health and Human Services (HHS) is authorizing providers to submit claims for dates of service March 20, 2020 through April 30, 2021*, for reimbursement of the following behavioral health and medical services delivered by telephone (audio only):

Behavioral Health Services

 DESCRIPTION OF SERVICES

PROCEDURE CODES

Psychiatric Diagnostic Evaluation

90791, 90792

Psychotherapy

90832, 90834, 90837, 90846, 90847, 90853

Peer Specialist Services

H0038

Screening, Brief Intervention, and Referral to Treatment (SBIRT)

99408, G2011, H0049

Substance Use Disorder Services

H0001, H0004, H0005

Mental Health Rehabilitation

H0034, H2011, H2012, H2014, H2017


Medical Services

 DESCRIPTION OF SERVICES

PROCEDURE CODES

Evaluation and Management (E/M)

99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215


Providers should continue to use the 95 modifier to indicate the occurrence of remote delivery.

Telemedicine and Telehealth During COVID-19

Superior HealthPlan has developed a Telemedicine Quick Reference Chart (PDF) (updated March 25, 2021) to help providers navigate telemedicine and telehealth reimbursement.

This chart reflects Medicare’s waiver of the geographic and place of service restrictions for Medicare. Additionally, an emergency rule related to the payment of telemedicine has been implemented, allowing state-regulated plans to allow telemedicine visits to be paid at the same rate as in-office visits.

Rural Health Clinics as Telehealth and Telemedicine Sites

Effective December 1, 2020, Federally Qualified Health Centers (FQHCs) may be reimbursed as telemedicine and telehealth distant site provider as permanent policy change per S.B. 670, Texas Legislature, Regular Session, 2019.

When submitting an encounter for a Rural Health Center (RHC) service delivered through telehealth or telemedicine, the existing RHC procedure code T1015 should be used, with the modifier 95 added to indicate use of the telehealth or telemedicine modality.

Claims Information

For full details regarding Telemedicine and Telehealth claims, please reference the following Texas Medicaid and Healthcare Partnership articles:

*Please note: Previously, the end date for this guidance was April 30, 2020, then extended to May 31, June 30, July 31, October 23, November 30, December 31, 2020, January 31, February 28 and March 31, 2021. Per HHS, guidance dates have been extended through April 30, 2021.