UPDATED: Superior Telemedicine and Telehealth Service Updates
Superior HealthPlan has developed a Telemedicine Quick Reference Chart (PDF) (updated September 28, 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, the Governor of Texas directed the Texas Department of Insurance (TDI) to issue an emergency rule related to the payment of telemedicine to allow state-regulated plans to allow telemedicine visits to be paid at the same rate as in-office visits.
Superior will continue to inform providers about any updates as we receive new information.
Claims for Telephone (Audio-Only) Medical Services Background
Providers may bill codes 99201-99205 and 99211-99215 for dates of service of March 15, 2020, through December 31, 2021*, to receive Medicaid reimbursement for telephone (audio-only) medical services.
To help ensure continuity of care during the COVID-19 (coronavirus) response, HHSC is authorizing providers to bill codes 99201-99205 and 99211-99215 for telephone (audio-only) medical (physician delivered) evaluation and management services delivered on March 15, 2020, through December 31, 2021*. Providers should continue to use the 95 modifier to indicate that remote delivery has occurred.
Telephonic evaluation and management services are not to be billed if clinical decision-making dictates a need to see the patient for an in-person or telemedicine (video) office visit within 24 hours or at the next available appointment. In those circumstances, the telephone service shall be considered a part of the subsequent office visit. If the telephone call follows an office visit performed and reported within the past seven calendar days for the same diagnosis, then the telephone services are considered part of the previous office visit and are not separately billed.
Claims for Telephone (Audio-Only) Behavioral Health Services Background
Providers may bill to receive Medicaid reimbursement for the following behavioral health services delivered by telephone (audio only) from March 15, 2020 through December 31, 2021*: Psychiatric Diagnostic Evaluation, Psychotherapy, Peer Specialist Services, Screening, Brief Intervention and Referral to Treatment (SBIRT), Substance Use Disorder Services, and Mental Health Rehabilitation services.
To help ensure continuity of care during the COVID-19 (coronavirus) response, HHSC is authorizing providers to bill the following codes for telephone (audio-only) delivered behavioral health services from March 15, 2020, through December 31, 2021*:
- 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
Providers should continue to use the 95 modifier to indicate that remote delivery has occurred.
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.
Providers can refer to the Texas Medicaid Provider Procedures Manual and Behavioral Health and Case Management Services Handbook for additional information about Texas Medicaid behavioral health benefits, as well as the Telecommunication Services Handbook.
- American Medical Association (AMA): COVID-19 Resource Center for Physicians
- AMA STEPS Forward: Telemedicine - Connect to Specialists and Facilitate Better Access to Care for Your Patients (Learning Module, Quiz and Resources)
- Centers for Medicare and Medicaid Services (CMS) Current Emergencies
- CMS: End-Stage Renal Disease Providers Toolkit
- CMS: Telehealth Services Fact Sheet (PDF)
- CMS: Telehealth Toolkit for General Practitioners
- COVID-19 Related State Actions
- Medicare Telemedicine Healthcare Provider Fact Sheet
- National Organization of State Offices of Rural Health: Telehealth Technologies and Preparing to Select a Vendor PDF
- Texas Medicaid & Healthcare Partnership Provider Procedures Manual
- University of Arizona: Directory Service Provider Telemedicine & Telehealth
- Using FaceTime for Telemedicine
Telemedicine Platforms for Providers Looking to Offer Telehealth Services
If you are interested in treating your members via phone and/or video, there are many vendors that offer secure solutions to easily incorporate these visits into your practice. We recommend looking at the following site for additional information:
- Texas Medical Association (TMA): Linked on the Telemedicine Resource Center of the TMA website.
- Texas e-Health Alliance: www.txeha.org/coronavirus
*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, March 31, April 30, May 31, June 30, July 31, August 31 and September 30, 2021. This notice is extended until December 31, 2021.