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UPDATED: Superior Telemedicine and Telehealth Service Updates

Date: 06/28/22

Superior HealthPlan has developed a Telemedicine Quick Reference Chart (PDF) 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. 

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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 August 31, 2022*, to receive Medicaid reimbursement for telephone (audio-only) medical services.

Key Details

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 August 31, 2022*. 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.

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Claims for Telephone (Audio-Only) Behavioral Health Services Background

Please Note: This information has been updated, please review: Update to HB4: Behavioral Health Services Delivered by Synchronous Audio-visual or Telephone (Audio-only) Interim Guidance

Providers may bill to receive Medicaid reimbursement for the following behavioral health services delivered by telephone (audio only) from March 15, 2020 through August 31, 2022*: Psychiatric Diagnostic Evaluation, Psychotherapy, Peer Specialist Services, Screening, Brief Intervention and Referral to Treatment (SBIRT), Substance Use Disorder Services, and Mental Health Rehabilitation services.

Key Details

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 August 31, 2022*:

  • Psychiatric Diagnostic Evaluation: 90791, 90792
  • Psychotherapy: 90832, 90834, 90837, 90846, 90847, 90853
  • Peer Specialist Services: H0038
  • Substance Use Disorder Services: H0001, H0004, H0005
  • Mental Health Rehabilitation: H0034, H2011, H2012, H2014, H2017

Beginning February 1, 2022, HHS authorizes fee-for-service providers to submit claims for reimbursement for the following behavioral health service. See full article for details: Screening, Brief Intervention, and Referral to Treatment (SBIRT): H0049, G2011, 99408

Providers should continue to use the 95 modifier to indicate that remote delivery has occurred.

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Additional Information

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.

Additional Resources

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:

Please Note: This information has been updated, please review: Update to HB4: Behavioral Health Services Delivered by Synchronous Audio-visual or Telephone (Audio-only) Interim Guidance