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UPDATED: Superior Telemedicine and Telehealth Service Updates

Date: 07/31/20

Superior HealthPlan has developed a Telemedicine Quick Reference Chart (updated 07/31/2020) 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 October 23, 2020*, 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 October 23, 2020*. 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

Providers may bill to receive Medicaid reimbursement for the following behavioral health services delivered by telephone (audio only) from March 15, 2020, through October 23*: 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 October 23, 2020*:

  • 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.

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Rural Health Clinics as Telehealth and Telemedicine Sites

To aid Rural Health Clinics (RHCs) in delivering care to individuals in response to COVID-19, RHCs may be reimbursed as telemedicine and telehealth distant site providers statewide for service dates from March 24, 2020 through October 23, 2020*.

When submitting an encounter for a RHC service delivered through telehealth or telemedicine, the existing RHC procedure codes T1015 and 99381 should be used, with the modifier 95 added to indicate use of the telehealth or telemedicine modality.

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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: Previously, the end date for this guidance was April 30, 2020, then extended to May 31, June 30 and July 31, 2020. Per HHS, guidance dates have been extended through October 23, 2020, unless the U.S. Secretary of Health and Human Services ends the public health emergency earlier. If the public health emergency ends earlier, HHS will provide additional information.