Live Video

April 2025

POLICY

Synchronous audiovisual technology – An interactive, two-way audio and video telecommunications platform that meets the privacy requirements of the Health Insurance Portability and Accountability Act.

Telemedicine/Telehealth Service Delivery: The following delivery methods may be used to provide telemedicine within fee-for-service (FFS) Medicaid:

Synchronous audiovisual technology between the distant site provider and the client in another location …

SOURCE: TX Medicaid Telecommunication Services Handbook, p. 9 (Apr. 2025). (Accessed Apr. 2025).

Texas Medicaid managed care organizations (MCOs) are prohibited from denying reimbursement for covered services solely because they are delivered remotely. MCOs must consider reimbursement for all medically necessary Medicaid-covered services that are provided using telemedicine or telehealth.

Texas Medicaid MCOs must determine whether to reimburse for a telemedicine or telehealth service based on clinical and cost effectiveness, among other factors.

Texas Medicaid MCOs cannot deny, limit, or reduce reimbursement for a covered health-care service or procedure based on the provider’s choice of telecommunications platform to provide the service or procedure using telemedicine or telehealth.

Providers should refer to individual MCO policies for additional coverage information.

Clinical and cost effectiveness determinations that result in prohibiting a service from being delivered using a synchronous audio-only technology, or store and forward technology in conjunction with synchronous audio-only technology are not considered denying, limiting, or reducing reimbursement for a covered health care service.

Telemedicine and telehealth services are reimbursed in accordance with 1 TAC §355.

In the event of a Declaration of State of Disaster, HHSC will issue direction to providers regarding the use of telemedicine or telehealth services to include the use of a synchronous telephone (audio-only) platform to provide covered services outside of the allowances described herein to the extent permitted by Texas law.

Declaration of State of Disaster is when to an executive order or proclamation is issued by the governor declaring a state of disaster in accordance with Texas Government Code §418.014.

A valid practitioner-patient relationship must exist between the distant site provider and the patient. A valid practitioner-patient relationship exists between the distant site provider and the patient if:

The distant site provider meets the same standard of care required for and in-person service.
The relationship can be established through:
- A prior in-person service.

- A prior telemedicine service that meets the delivery method requirements specified in Texas Occupations Code §111.005(a)(3).

- The current telemedicine service that meets the delivery method requirements specified in Texas Occupations Code §111.005(a)(3).

A call coverage agreement established in accordance with Texas Medical Board (TMB) administrative rules in 22 TAC §177.20.

SOURCE: TX Medicaid Telecommunication Services Handbook, p. 5, 7, 8 (Apr. 2025). (Accessed Apr. 2025).

The following delivery methods may be used to provide telemedicine [telehealth] within fee-for-service (FFS) Medicaid:

Synchronous audiovisual technology between the distant site provider and the client in another location
Synchronous audio-only technology between the distant site provider and the client in another location
Store and forward technology in conjunction with synchronous audio-only technology between the distant site provider and the client in another location. The distant site provider must use one of the following:
- Clinically relevant photographic or video images, including diagnostic images
- The client’s relevant medical records, such as medical history, laboratory and pathology results, and prescriptive histories

SOURCE: TX Medicaid Telecommunication Services Handbook, p. 9, 13-14, (Apr. 2025). (Accessed Apr. 2025).

Fees for telemedicine, telehealth, and home telemonitoring services are adjusted within available funding as described in §355.201 of this title (relating to Establishment and Adjustment of Reimbursement Rates by the Health and Human Services Commission).

SOURCE: TX Admin. Code, Title 1 Sec. 355.7001, (Accessed Apr. 2025).

CSHCN Program

Authorization is not required for telemedicine or telehealth services, however prior authorization may be required for the individual procedure codes billed.

Telemedicine and telehealth services must be provided in compliance with standards established by the respective licensing or certifying board of the professional providing the services.

Only those services that involve direct face-to-face interactive video communication between the client and the distant-site provider constitute a telemedicine or telehealth service. No separate reimbursement will be made for the cost of telemedicine and telehealth hardware or equipment, electronic documentation, and transmissions. Telephone conversations, chart reviews, electronic mail messages, and fax transmissions alone do not constitute a telemedicine or telehealth interactive video service and will not be reimbursed as telemedicine or telehealth services.

Telecommunication services may be reimbursed the lower of the billed amount or the amount allowed by Texas Medicaid.

SOURCE: TX Medicaid Telecommunication Services Handbook, p. 3-4, 13 (Mar. 2025). (Accessed Apr. 2025).

ELIGIBLE SERVICES/SPECIALTIES

Telemedicine medical services and telehealth services are authorized service delivery methods for Texas Medicaid covered services as provided in this section. All telemedicine medical services and telehealth services are subject to the specifications, conditions, limitations, and requirements established by the Texas Health and Human Services Commission (HHSC) or its designee.

A client must not be required to receive a covered service as a telemedicine medical service or telehealth service except in the event of an active declaration of state of disaster and at the direction of HHSC.
In the event of a declaration of state of disaster, HHSC may issue direction to providers regarding the use of telemedicine medical services and telehealth services, including the use of an audio-only platform, to provide covered services to clients who reside in the area subject to the declaration of state of disaster.
HHSC considers the following criteria when determining whether a covered service may be delivered as telemedicine medical service or telehealth service, including via an audio-only platform:
- Clinical effectiveness;
- Cost effectiveness;
- Health and safety;
- Patient choice and access to care; and
- Other criteria specific to the service.

Conditions for reimbursement applicable to telemedicine medical services.

The provider must be enrolled in Texas Medicaid.
The covered services must be provided in compliance with Texas Occupations Code Chapter 111 and Title 22 Texas Administrative Code Chapter 174 (relating to Telemedicine).
A telemedicine medical service must be designated for reimbursement by HHSC. Telemedicine medical services designated for reimbursement are those that are clinically effective and cost-effective, as determined by HHSC and in accordance with paragraph (3) of this section. Covered services that HHSC has determined are clinically effective and cost-effective when provided as a telemedicine medical service can be found in the Texas Medicaid Provider Procedures Manual (TMPPM).

*See regulations for eligible sites topic for conditions for school-based settings.

Conditions for reimbursement applicable to telehealth services.

The provider must be enrolled in Texas Medicaid.
The covered services must be provided in compliance with Texas Occupations Code Chapter 111 and standards established by the respective licensing or certifying board of the professional providing the telehealth service.
Telehealth services must be designated for reimbursement by HHSC. Telehealth services designated for reimbursement are those that are clinically effective and cost-effective, as determined by HHSC and in accordance with paragraph (3) of this section. Covered services that HHSC has determined are clinically effective and cost-effective when provided as a telehealth service can be found in the TMPPM.

Conditions for reimbursement applicable to both telemedicine medical services and telehealth services.

Preventive health visits under Texas Health Steps (THSteps), also known as Early and Periodic Screening, Diagnosis and Treatment program, are not reimbursed if performed using telemedicine medical services or telehealth services. Health care or treatment provided using telemedicine medical services or telehealth services after a THSteps preventive health visit for conditions identified during a THSteps preventive health visit may be reimbursed.
Documentation in the patient’s medical record for a telemedicine medical service or a telehealth service must be the same as for a comparable in-person evaluation.
Providers of telemedicine medical services and telehealth services must maintain confidentiality of protected health information (PHI) as required by Title 42 Code of Federal Regulations (CFR) Part 2, 45 CFR Parts 160 and 164, Texas Occupations Code Chapters 111 and 159, and other applicable federal and state law.
Providers of telemedicine medical services and telehealth services must comply with the requirements for authorized disclosure of PHI relating to patients in state mental health facilities and residents in state supported living centers, which are included in, but not limited to, 42 CFR Part 2, 45 CFR Parts 160 and 164, Texas Health and Safety Code §611.004, and other applicable federal and state law.
Telemedicine medical services and telehealth services are reimbursed in accordance with Chapter 355 of this title (relating to Reimbursement Rates).

SOURCE: TX Admin Code Title 1, Sec. 354.1432, (Accessed Apr. 2025).

Telemedicine & Telehealth

Not all Medicaid-covered services are authorized by HHSC for telemedicine or telehealth delivery in fee-for-service. Providers must always ensure the covered service is allowable by HHSC for telemedicine or telehealth services delivery.

Note: For example, if a service is authorized for telemedicine or telehealth delivery only when using synchronous audiovisual technology, that service may not be delivered using store and forward technology, store and forward technology in conjunction with synchronous audio-only technology, synchronous audio-only technology, or asynchronous audio-only technology.

Telemedicine or telehealth may be provided if clinically appropriate and safe, as determined by the provider, and agreed to by the person receiving services. Whenever possible, HHSC encourages face-to-face interaction, such as an in-person visit.

SOURCE: TX Medicaid Telecommunication Services Handbook, p. 6 (Apr. 2025). (Accessed Apr. 2025).

Telemedicine and telehealth services must be provided in compliance with standards established by the respective licensing or certifying board of the professional providing the services.

The use of telemedicine and telehealth services within intermediate care facilities for individuals with intellectual disabilities (ICD-IID) and State Supported Living Centers is subject to the policies established by the Health and Human Services Commission (HHSC).

More than one medically necessary telemedicine service or telehealth service may be reimbursed for the same date and same place of service if the services are billed by providers of different specialties.

Telemedicine medical services, also known as telemedicine, are allowable for Texas Medicaid. Telemedicine has the meaning assigned by Texas Occupations Code §111.001. Telemedicine services are defined as health-care services delivered by a physician licensed in Texas or a health professional who acts under the delegation and supervision of a health professional licensed in Texas and within the scope of the health professional’s license to a client at a different physical location using telecommunications or information technology. Telemedicine excludes teledentistry services.

Telehealth services, also known as telehealth, are allowable for Texas Medicaid. Telehealth has the meaning assigned by Texas Occupations Code §111.001. Telehealth services are defined as health-care services, other than telemedicine medical services or a teledentistry service, delivered by a health professional licensed, certified or otherwise entitled to practice in Texas and acting within the scope of the health professional’s license, certification or entitlement to a patient at a different physical location other than the health professional using telecommunications or information technology.

Telehealth services are reimbursed in accordance with 1 TAC §355.

Procedure codes that are reimbursed to distant site providers when billed with the 95 modifier (synchronous audiovisual technology) are included in the individual TMPPM handbooks. Procedure codes that indicate remote (telemedicine/telehealth) delivery in the description do not need to be billed with the 95 modifier.

Behavioral health procedure codes that are reimbursed to distant site providers when billed with the FQ modifier (audio-only services) are included in the individual TMPPM handbooks. Procedure codes that indicate telephone or audio-only delivery in their description do not need to be billed with the FQ modifier.

See manual for codes MCOs must reimburse when delivered via telehealth.

SOURCE: TX Medicaid Telecommunication Services Handbook, p. 4, 7-9 & 12 (Apr. 2025). (Accessed Apr. 2025).

Conditions for reimbursement applicable to telemedicine and telehealth provided using a synchronous audiovisual technology platform, or using store and forward technology in conjunction with synchronous audio-only are those that meet the following conditions:

Must be designated for reimbursement by HHSC.
Must be clinically effective and cost-effective, as determined and published in the benefit language by HHSC.
May not be denied solely because an in-person medical service between a provider and client did not occur.
May not be limited by requiring the provider to use a particular synchronous audiovisual technology platform to receive reimbursement for the service.

Other conditions for reimbursement applicable to services may vary by service type. Providers may refer to the appropriate TMPPM handbook for additional information on synchronous audiovisual technology platform coverage conditions.

Note: Telemedicine and telehealth services that HHSC has determined are clinically effective and cost-effective when provided via a synchronous audiovisual technology platform or using store and forward technology in conjunction with synchronous audio-only technology can be found in the appropriate TMPPM handbooks.

SOURCE: TX Medicaid Telecommunication Services Handbook, p. 6 (Apr. 2025). (Accessed Apr. 2025).

Providers must defer to the needs of the person receiving services, allowing the mode of service delivery to be accessible, person- and family-centered, and primarily driven by the person’s choice and not provider convenience.

Providers must provide outpatient mental health services to Medicaid eligible persons in accordance with accepted medical community standards and standards that govern occupations, as explained in Title 1 Texas Administrative Code (TAC) §371.1659. In addition, providers must deliver, to include delivery by telemedicine or telehealth, outpatient mental health services in full accordance with all applicable licensure and certification requirements.

During a Declaration of State of Disaster, the Health and Human Services Commission (HHSC) may issue direction to providers regarding the use of a telemedicine or telehealth services to include the use of a synchronous telephone (audio-only) platform to provide covered services outside of the allowances described herein to the extent permitted by Texas law. A Declaration of State of Disaster is when an executive order or proclamation is issued by the governor declaring a state of disaster in accordance with Section 418.014 of the Texas Government Code.

Outpatient Mental Health Services

The following outpatient mental health services may be provided by synchronous audiovisual technology if clinically appropriate and safe, as determined by the billing provider, and agreed to by the person receiving services. Outpatient mental health services provided by synchronous audiovisual technology must be billed using modifier 95.

Psychiatric diagnostic evaluation services with and without medical services
Psychotherapy (individual, family, or group) services
Pharmacological management services (most appropriate E/M code with modifier UD) for psychiatric care only
Neurobehavioral services
Neuropsychological and psychological testing services if the following conditions are met:
- The psychometric test must be available in an online format, except for tests that are administered and responded to orally;
- The provider, or test administrator, must observe the person, in real-time, for the duration of the test; and
- The provider delivers the psychometric test in accordance with their licensing board and professional guidelines.

See manual for procedure codes and specific instructions.

Follow Up Visits

A follow-up visit may be completed in-person or through the use of synchronous audiovisual technology, or synchronous telephone (audio-only) technology. Follow-up visits completed using synchronous audiovisual technology or synchronous telephone (audio-only) technology should only be provided if agreed to by the client, parent, or legal guardian.

Intellectual and Developmental Disabilities Service Coordination

Supportive Encounter (Type B): A face-to-face, telephone, or telemedicine contact with a person or with a collateral on the person’s behalf to provide service coordination.

Mental Health Targeted Case Management (MHTCM) Services

MHTCM services may be provided by synchronous audiovisual technology if clinically appropriate and safe, as determined by the billing provider, and agreed to by the person receiving services or LAR. In addition, approval to deliver the services by synchronous audiovisual technology must be documented in the plan of care of the person receiving services. MHTCM services provided by synchronous audiovisual technology must be billed using modifier 95.

Intensive Case Management for Persons 20 Years of Age and Younger

Intensive case management services are primarily community-based, meaning that services are provided in whatever setting is clinically appropriate and person-centered, to include telehealth delivery.

Mental Health Rehabilitative Services

The following MHR services may be provided by synchronous audiovisual technology if clinically appropriate and safe, as determined by the billing provider, and agreed to by the person receiving services or LAR. In addition, except for crisis intervention services, approval to deliver the services by synchronous audiovisual technology must be documented in the plan of care of the person receiving services. MHR services provided by synchronous audiovisual technology must be billed using modifier 95.

Medication training and support
Skills training and development
Psychosocial rehabilitation services
Crisis intervention services
- Documented approval of the mode of delivery in the plan of care is not required prior to the delivery of crisis intervention services by synchronous audiovisual technology.

Peer Specialist Services

Peer specialist services may be provided by synchronous audiovisual technology if clinically appropriate and safe, as determined by the billing provider, and agreed to by the person receiving services. In addition, approval to deliver the services by synchronous audiovisual technology must be documented in the person-centered recovery plan of the person receiving services. Peer specialist services provided by synchronous audiovisual technology must be billed using modifier 95.

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

SBIRT services may be provided by synchronous audiovisual technology if clinically appropriate and safe, as determined by the provider, and agreed to by the person receiving services. SBIRT services provided by synchronous audiovisual technology must be billed using modifier 95.

Substance Use Disorder

The following SUD services may be provided by synchronous audiovisual technology if clinically appropriate and safe, as determined by the billing provider, and agreed to by the person receiving services. SUD services provided by synchronous audiovisual technology must be billed using modifier 95.

Comprehensive assessment
Individual and group counseling
MAT services – Prescribing of certain MAT medications may be done via telemedicine presuming all other applicable state and federal laws and regulations are followed.

Case Management for Children and Pregnant Women (CPW)

CPW services may be provided using synchronous audiovisual technologies if clinically appropriate and safe, as determined by the provider, and agreed to by the client receiving services. Whenever possible, HHSC encourages face-to-face interaction, such as an in-person visit.

The Telecommunication Services Handbook (Vol. 2, Provider Handbooks) for information on policy restrictions for services delivered by synchronous telephone (audio-only) technologies. Services delivered using audio-only technologies must be billed using
the 93 modifier.

SOURCE: TX Medicaid Behavioral Health and Case Management Services Handbook, (Apr. 2025). (Accessed Apr. 2025).

Children’s Services

Telehealth services may be provided using synchronous audiovisual technologies if clinically appropriate and safe, as determined by the provider, and agreed to by the client receiving services. Whenever possible, HHSC encourages face-to-face interaction, such as an in-person visit, as well as the use of synchronous audiovisual technology over synchronous telephone (audio-only) technology of telehealth services.

Providers must defer to the needs of the client receiving services, allowing the mode of service delivery to be accessible, person- and family-centered, and primarily driven by the client in service’s choice and not provider convenience.

Services delivered by synchronous audiovisual technology will require participation of a parent or caregiver to assist with the treatment.

Therapy assistants may deliver services and receive supervision using synchronous audiovisual technology in accordance with each discipline’s rules. Providers should refer to state practice rules and national guidelines regarding supervision requirements for each discipline

The following procedure codes may be provided through telehealth delivery using synchronous audiovisual technology:

Specialized skills training (SST)
Targeted case management (TCM)
Physical therapy (PT) evaluations and reevaluations
Occupational therapy (OT) evaluations and reevaluations
PT and OT treatments

Speech therapy (ST) evaluations and reevaluations
ST treatments

Providers must use modifier 95 to indicate remote delivery. Providers are reminded to use the required modifiers GP, GO, and GN on all claims except evaluation and re-evaluation procedures for physical, occupational, or speech therapy treatment.

See manual for excluded services.

Applied Behavioral Analysis

Services must be provided in compliance with the Texas Health Step-Comprehensive Care Program, medical standards for telehealth, and these Medicaid Autism Services requirements, which may be more restrictive than general ABA practice.

Some service delivery to children or youth and to the parents or caregivers may be delivered remotely. It is the LBA’s responsibility to ensure that remotely delivered telehealth services are within scope of practice, are not contraindicated for the child or youth, family, or particular situation, are clinically appropriate and effective, and are in compliance with Texas licensure and standards for telehealth as well as follow all Medicaid, Texas Health Steps-CCP and the Medicaid Autism Services requirements.

ABA evaluation and treatment services may only be delivered via telehealth using synchronous audio-visual technology.

Health and Behavior Assessment and Intervention

HBAI services may be provided by synchronous audiovisual technology if clinically appropriate and safe, as determined by the provider, and agreed to by the person receiving services. HBAI services provided by synchronous audiovisual technology must be billed using modifier 95. See manual for eligible services.

Medical Nutrition Counseling Services (CCP)

Certain telehealth services may be provided for medical nutrition therapy and nutrition counseling services clients if clinically appropriate and safe, as determined by the provider, and agreed to by the person receiving services. Whenever possible, HHSC encourages face-to-face interactions, such as an in-person visit, as well as the use of synchronous audiovisual technology over synchronous telephone (audio-only) technology of telehealth services. Therefore, providers must document in the person’s medical record the reason(s) that services were delivered by synchronous telephone (audio-only) technology. See chart in manual for services are authorized for telehealth delivery using synchronous audiovisual and synchronous telephone (audio-only) technologies.

The procedure codes in the table above may be delivered by synchronous telephone (audio-only) technology only during certain PHE or natural disasters.

Medical nutrition counseling services (procedure code S9470) are authorized for telehealth delivery using synchronous audiovisual and synchronous telephone (audio-only) technologies, when noted.

Medical nutrition counseling services (procedure code S9470) may be delivered by synchronous telephone (audio-only) technology only during certain PHE or natural disasters. Services provided by synchronous audio-visual technology must be billed using modifier 95. Services delivered using audio-only technologies must be billed using modifier 93. Documentation requirements for a telehealth service are the same as for an in-person visit and must accurately reflect the services rendered. Documentation must identify the means of delivery when provided.

During a Declaration of State of Disaster, the Texas Health and Human Services Commission (HHSC) may issue direction to providers regarding the use of telehealth services to include the use of a synchronous telephone (audio-only) platform to provide covered services outside of the allowances described herein to the extent permitted by Texas law. A Declaration of State of Disaster is when an executive order or proclamation is issued by the governor declaring a state of disaster in accordance with Section 418.014 of the Texas Government Code.

Refer to: The Telecommunication Services Handbook (Vol. 2, Provider Handbooks) for information on restrictions for services delivered by synchronous telephone (audio-only) technologies.

Medical Checkups During a Declaration of State Disaster

The following limitations apply to all THSteps preventive medical checkups and exception-to-periodicity checkups during a Declaration of State Disaster when HHSC issues direction regarding the use of synchronous audiovisual and synchronous telephone (audio-only) technologies:

Clients who are 2 years through 20 years of age may receive a THSteps medical checkup or exception-to-periodicity checkup using synchronous audiovisual or synchronous telephone (audio-only) technologies.
Clients from birth through 2 years of age may not receive a THSteps checkup or exception-to-periodicity checkup using synchronous audiovisual or synchronous telephone (audio-only) technologies.
Clients from birth through 24 months of age must receive in-person checkups.

A medical checkup provided using synchronous audiovisual or synchronous telephone (audio-only) technologies must be completed according to the age-specific checkup requirements listed on the THSteps Periodicity Schedule.

Synchronous audiovisual delivery for medical checkups is preferred over synchronous telephone (audio-only) delivery.

An in-person THSteps follow-up visit must be completed within six months of the synchronous audiovisual or synchronous telephone (audio-only) checkup in order for the checkup to be considered a complete THSteps checkup.

When HHSC issues direction, the following THSteps medical checkup services are authorized for delivery using synchronous audiovisual or synchronous telephone (audio-only) technologies during a Declaration of State Disaster (see manual).

Medical checkups and exception-to-periodicity checkups provided using synchronous audiovisual or synchronous telephone (audio-only) technologies are limited to checkups for clients who are over 24 months of age for the following procedure codes (see manual).

Medical checkups for clients who are 2 years of age or younger must be completed in-person and may not be completed using synchronous audiovisual or synchronous telephone (audio-only) technologies (procedure codes 99381, 99382, 99391 and 99392).

THSteps providers should use their clinical judgement regarding which checkup components may be appropriate for completion using synchronous audiovisual or synchronous telephone (audio-only) technologies.

THSteps providers are encouraged to ensure that clients receiving a medical checkup using synchronous audiovisual or synchronous telephone (audio-only) technologies receive age-appropriate vaccines and laboratory screenings in a timely manner.

Medical checkup services using synchronous audiovisual or synchronous telephone (audio-only) technologies should only be provided if agreed to by the client or parent/guardian.

See Children’s Services Handbook for additional information and a list of procedure codes.

Teledentistry

Teledentistry services may be reimbursed by Texas Medicaid. When provided as a teledentistry service procedure code D0120 or D0140, must be billed with teledentistry procedure code D9995.

Teledentistry refers to the use of communication technology by a dentist to provide dental care services to a patient at a different physical location than the office setting.

Texas Health Steps dental providers must follow the rules and regulations of the Texas Dental Practice Act and Texas Board of Dental Examiners (TSBDE) in regard to the practice of teledentistry and the permissible work that may be delegated to a licensed dental hygienist or dental assistant.

Dental services delivered using teledentistry must meet the same standard of care as the same dental health service or procedure provided in an in-person setting.

For dental services delivered through a dental maintenance organization (DMO), providers must refer to the individual DMO benefit package for information on teledentistry services. The service must be delivered using only synchronous real-time audiovisual technologies.

Services provided through teledentistry outside of the frequency specified in the periodicity schedule may be reimbursed when medically necessary and criteria for procedure code D0120 or D0140 are met.

A periodic oral evaluation (procedure code D0120) may be delivered as a teledentistry service when the following criteria are met:

The client must be 3 years through 20 years of age.
The teledentistry platform must be operated at the patient site by a dental hygienist trained in its operation.
A limited problem-focused oral evaluation (procedure code D0140) may be delivered as a teledentistry service when the following criteria are met:
The client must be birth through 20 years of age.
The teledentistry platform must be operated at the patient site by a dental assistant or hygienist trained in its operation.

Real-time encounter procedure code D9995 must be included on the claim form when procedure code D0120 or D0140 is provided as a teledentistry service. Procedure code D9995 is not separately reimbursable.

When procedure code D0120 or D0140 is provided as a teledentistry service, additional documentation in the client’s dental record must indicate that the service was provided using synchronous real-time audiovisual technologies. The documentation must include the following:

The name and credentials of the dental health care professional
The location of the dentist at the time of service

SOURCE: TX Medicaid Children’s Services Handbook, (Apr. 2025), (Accessed Apr. 2025).

Telemedicine medical services used for the treatment of chronic pain with scheduled drugs via audio-only is prohibited, except in certain circumstances (see audio-only section for more info).

Treatment of a client for acute pain with scheduled drugs using telemedicine is permitted, as provided by 22 TAC §174.5(e). Acute pain is defined by 22 TAC §170.2(2).

All physicians must comply by 22 TAC §174.5 when issuing prescriptions through a telemedicine service.

SOURCE: TX Medicaid Telecommunication Services Handbook, p. 10, (Apr. 2025). (Accessed Apr. 2025).

LEAs that participate in the SHARS program may be reimbursed for telehealth and telemedicine services delivered to children in school-based settings, or while receiving remote instruction.

A school-based setting is defined in Texas Government Code §531.02171(b) as a school district or an open enrollment charter school.

Remote instruction is defined according to requirements set forth by TEA and includes technology based learning in home or community-based settings.

Providers may be reimbursed for telehealth and telemedicine services delivered to children in school based settings, or while learning remotely with the following criteria:

Reimbursement for providers is only available when the patient site is a school, home, or community-based setting.
- A patient site is the physical location of the student while the service is being rendered.
Reimbursement for providers is only available when the distant site is a school or office-based setting.
- A distant site is the physical location of the Texas Medicaid provider rendering the service.
A telehealth or telemedicine visit may not be conducted if the provider and student are both physically located at the same school at the time the services are rendered.
All medical necessity criteria for in-person services apply when services are delivered to children in school-based settings.

Providers must be able to defer to the needs of the student receiving services, allowing the mode of service delivery (synchronous audiovisual, synchronous telephone (audio-only), or in-person) to be accessible.

Providers should obtain informed consent for treatment from the student’s parent or legal guardian and the student prior to rendering a telehealth or telemedicine service. Verbal consent is permissible and should be documented in the student’s medical record.

Services delivered by synchronous audiovisual or synchronous telephone (audio-only) technology may require participation of a parent or caregiver to assist with the treatment.

During a Declaration of State of Disaster, HHSC may issue direction to providers regarding the use of a telemedicine or telehealth service to include the use of a synchronous telephone (audio-only) platform to provide covered services outside of the allowances described herein to the extent permitted by Texas law.

A Declaration of State of Disaster is when an executive order or proclamation is issued by the governor declaring a state of disaster in accordance with Section 418.014 of the Texas Government Code.

Telehealth services are a benefit of Texas Medicaid and SHARS. Telehealth services has the meaning assigned by Texas Occupations Code (TOC) §111.001. Telehealth services are defined as healthcare services, other than telemedicine medical services or a teledentistry service, delivered by a health professional licensed, certified, or otherwise entitled to practice in Texas and acting within the scope of the health professional’s license, certification, or entitlement to a patient at a different physical location than the health professional using telecommunications or information technology.

Telehealth services must be provided in compliance with standards established by the respective licensing or certifying board of the professional providing the services.

LEAs that participate in the SHARS program may be reimbursed for telehealth occupational therapy (OT), physical therapy (PT), speech therapy (ST), counseling, and psychological services.

All other reimbursement and billing guidelines that are applicable to in-person services will also apply when OT, PT, ST, counseling, and psychological services are delivered as telehealth services.

OT, PT, ST, counseling, and psychological telehealth services provided by LEAs during school hours through SHARS may be delivered via synchronous audiovisual technologies.

Synchronous audiovisual technology is defined as an interactive, two-way audio and video telecommunications platform that meets the privacy requirements of HIPAA.

Synchronous Audiovisual Technology

The following procedure codes may be provided to children eligible through SHARS as telehealth services via synchronous audiovisual technology if clinically appropriate (as determined by the treating provider), safe and agreed to by the student receiving services.

The patient site must be a school, home, or community-based setting in order for the distant site provider to be eligible for reimbursement of these services.

All telehealth services provided by synchronous audiovisual technology must be billed using modifier 95.

The following procedure codes must be billed for telehealth services delivered via synchronous audiovisual technology:

See manual for additional details for synchronous audio visual technology and telemedicine services.

SOURCE: TX Medicaid School Health and Related Services (SHARS) Handbook, (Apr. 2025). (Accessed Apr. 2025).

In addition to the service requirements in this division, a child or adolescent must receive additional assessments, including a developmental assessment and history of trauma assessment, performed by an LPHA with appropriate training and experience in the assessment and treatment of children in a crisis setting. The assessments must:

be administered in person or through telehealth or telemedicine medical services; and
include the individual’s parents, LAR, or adult caregiver, as applicable and as clinically appropriate according to the child’s or adolescent’s age, functioning, and current living situation.

SOURCE: TX Admin Code, Title 26, Part 1 Ch. 306, Sec. 306.67, (Accessed Apr. 2025).

In providing covered benefits to a child with special health care needs, a health plan provider must permit benefits to be provided through telemedicine medical services, teledentistry dental services, and telehealth services in accordance with policies developed by the commission. See statute for additional requirements.

SOURCE: TX Statute 62.157 (Accessed Apr. 2025).

Federally Qualified Health Center Services Reimbursement

A visit is a face-to-face, telemedicine, or telehealth encounter between an FQHC patient and a physician, physician assistant, nurse practitioner, certified nurse-midwife, visiting nurse, a qualified clinical psychologist, clinical social worker, other health professional for mental health services, dentist, dental hygienist, or an optometrist. Encounters with more than one health professional and multiple encounters with the same health professional that take place on the same day and at a single location constitute a single visit, except where one of the following conditions exist:

after the first encounter, the patient suffers illness or injury requiring additional diagnosis or treatment; or

the FQHC patient has a medical visit and an “other” health visit, as defined in paragraph (13) of this subsection.

A medical visit is a face-to-face, telemedicine, or telehealth encounter between an FQHC patient and a physician, physician assistant, nurse practitioner, certified nurse midwife, or visiting nurse. An “other” health visit includes, but is not limited to, a face-to-face, telemedicine, or telehealth encounter between an FQHC patient and a qualified clinical psychologist, clinical social worker, other health professional for mental health services, a dentist, a dental hygienist, an optometrist, or a Texas Health Steps Medical Screen.

SOURCE: TX Admin Code, Title 1, Part 15, Ch. 355 Subchapter J, 355. 8261. (Accessed Apr. 2025).

Physical Therapy, Occupational Therapy, and Speech Therapy

Providers must defer to the needs of the person receiving services, allowing the mode of service delivery (synchronous audiovisual or in-person) to be accessible, person- and family-centered, and primarily driven by the person’s choice and not provider convenience.

Evaluation, reevaluation, and treatment of some PT, OT, and ST services may be provided by synchronous audiovisual technology.

Telehealth services for OT, PT or ST by synchronous audiovisual technology are allowed for specific procedure codes if clinically appropriate as determined by the practitioner, per standard of care, safe, agreed to by the person receiving services or by the legally authorized representative (LAR), and in compliance with each discipline’s rules.

The following procedure codes may be provided by synchronous audiovisual technology:

Physical Therapy Evaluations- Low, Moderate, and High Complexity and re-evaluation
Occupational Therapy Evaluation– Low, Moderate, and High Complexity and re-evaluation
PT or OT Services (individual or group)
Community reintegration (procedure code 97537) may be provided if the person receiving services is currently receiving other therapeutic procedure codes and may not be billed separately.
Speech Evaluations and re-evaluations
ST (individual or group) services
The provider should obtain informed consent for treatment from the patient, patient’s parent, or the patient’s legal guardian prior to rendering a telehealth service. Verbal consent is permissible and should be documented in the client’s medical record.
Services delivered by synchronous audiovisual technology may require participation of a caregiver or parent to assist with the treatment.
Therapy assistants may deliver services and receive supervision by synchronous audio- visual technology within limits outlined in each discipline’s rules. Providers should refer to state practice rules and national guidelines regarding supervision requirements for each discipline.
Providers must use modifier 95 to indicate remote delivery. Providers are reminded to use the required modifiers GP, GO, and GN on all claims for physical, occupational, or speech therapy treatment

See section 4.5 in the manual for a list of telehealth service procedure codes and section 4.8.1 for a list of in-person procedure codes.

SOURCE: TX Medicaid Physical Therapy, Occupational Therapy, and Speech Therapy Services Handbook pg. 9-10 (Apr. 2025). (Accessed Apr. 2025).

Physical Therapy, Occupational Therapy, and Speech and Language Pathology as a Telehealth Service.

Except as described in subsection (c) of this section, a service provider of physical therapy, occupational therapy, or speech and language pathology may provide physical therapy, occupational therapy, or speech and language pathology to an individual as a telehealth service.

If a service provider of physical therapy, occupational therapy, or speech and language pathology provides physical therapy, occupational therapy, or speech and language pathology to an individual as a telehealth service, a program provider must ensure that the service provider:

uses a synchronous audio-visual platform to interact with the individual, supplemented with or without asynchronous store and forward technology;
does not use an audio-only platform to provide the service; and
before providing the telehealth service:
- obtains the written informed consent of the individual or LAR to provide the service; or
- obtains the individual or LAR’s oral consent to receive the telehealth service and documents the oral consent in the individual’s record.

A program provider must ensure that a service provider of physical therapy, occupational therapy, or speech and language pathology performs certain services in person, as required by the Texas Medicaid Provider Procedures Manual. See regulation for list.

SOURCE: 26 TAC Sec. 262.9, (Accessed Apr. 2025).

Providers must provide the services to Medicaid eligible clients in accordance with accepted medical community standards and standards that govern occupations, as explained in Title 1 Texas Administrative Code (TAC) §371.1659. In addition, providers must deliver, to include delivery by telemedicine or telehealth, services in full accordance with all applicable licensure and certification requirements.

During a Declaration of State of Disaster, the Health and Human Services Commission (HHSC) may issue direction to providers regarding the use of a telemedicine or telehealth service to include the use of a synchronous telephone (audio-only) platform to provide covered services outside of the allowances described herein to the extent permitted by Texas law. A Declaration of State of Disaster is when an executive order or proclamation is issued by the governor declaring a state of disaster in accordance with Section 418.014 of the Texas Government Code.

The following office and other outpatient services may be provided by synchronous audiovisual technology if clinically appropriate and safe, as determined by the provider, and agreed to by the client receiving services. New and established patient services provided by synchronous audiovisual technology must be billed with modifier 95.

See manual for procedure codes that can be reimbursed for telemedicine (physician-delivered) evaluation and management to new and established clients.

SOURCE: TX Medicaid Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook, (Apr. 2025), pg. 180 (Accessed Apr. 2025).

Other Family Planning Office or Outpatient Visits

New and established patient E/M services for general family planning visits (procedure codes 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, and 99215) may be provided via a telemedicine service delivered using synchronous audiovisual technology if clinically appropriate and safe, as determined by the provider, and agreed to by the person receiving services. Whenever possible, HHSC encourages face-to-face interaction, such as an in-person visit.

New and established patient E/M services delivered using synchronous audiovisual technology must be billed using the 95 modifier.

Documentation requirements for a telemedicine service are the same as for an in-person visit and must accurately reflect the services rendered. Documentation must identify the service delivery method when provided via telemedicine.

During a Declaration of State of Disaster, HHSC may issue direction to providers regarding the use of a telemedicine or telehealth services to include the use of a synchronous telephone (audio-only) platform to provide covered services outside of the allowances described herein. A Declaration of State of Disaster is when an executive order or proclamation by the governor declaring a state of disaster in accordance with Section 418.014 of the Texas Government Code.

SOURCE: TX Medicaid Gynecological, Obstetrics, and Family Planning Title XIX Services Handbook pg. 9-10, (Apr. 2025). (Accessed Apr. 2025).

Healthy Texas Women Program/HTW Plus

Certain telemedicine and telehealth services may be provided for HTW clients if clinically appropriate and safe, as determined by the provider, and agreed to by the person receiving services. Whenever possible, HHSC encourages face-to-face interactions, such as an in-person visit, as well as the use of synchronous audio-visual technology over synchronous telephone (audio-only) technology of telemedicine and telehealth services. Therefore, providers must document in the person’s medical record the reason(s) for why services were delivered by synchronous telephone (audio-only) technology. The following HTW services are authorized for telemedicine delivery using synchronous audiovisual and synchronous telephone (audio-only), when noted, technologies. See manual for codes.

New patient and established client services provided by synchronous audiovisual technology must be billed using modifier 95. See manual for procedure codes are for new and established client services.

Established client service (procedure code 99211) is only during certain public health emergencies. Procedure codes that indicate remote (telemedicine medical and telehealth services) delivery in the description do not need to be billed with the 95 modifier.

FQHCs and RHCs may be reimbursed for telemedicine and telehealth in the following manner:

The distant site provider fee is reimbursable as a prospective payment system (PPS), alternative prospective payment system (APPS), or AIR (All Inclusive Rate) PPS.
The facility fee (procedure code Q3014) is an add-on procedure code that should not be included in any cost reporting that is used to calculate a FQHC PPS, APPS, or the RHC AIR (All Inclusive Rate) PPS per visit encounter rate.

See manual for non-behavioral health services that can be delivered by telemedicine and telehealth services.

SOURCE: TX Medicaid Healthy Texas Women Program Handbook, (Apr. 2025), pg. 12-13 (Accessed Apr. 2025).

Notwithstanding §263.8(a) of this chapter (relating to Comprehensive Nursing Assessment), the comprehensive nursing assessment completed by an RN is not required to be completed in person for an individual who resides in the disaster area, if the RN conducts the assessment as a telehealth service or by telephone.

SOURCE: 26 TAC Sec. 263.1000, (Accessed Apr. 2025).

An assessment of an individual may be performed as a telemedicine medical service or a telehealth service, including via an audio-only platform, in accordance with the requirements and limitations of Subchapter A, Division 33 of this chapter (relating to Advanced Telecommunications Services).

A service described in this subsection may be delivered as a telemedicine medical service or a telehealth service, including via an audio-only platform, in accordance with the requirements and limitations of Subchapter A, Division 33 of this chapter. The comprehensive provider agency and staff members must implement procedures to ensure that each individual is provided mental health services based on:

the assessment conducted under subsection (a) of this section;
medical necessity as determined by an LPHA; and
when available, physical health care needs as determined by a physician, physician assistant, or advanced practice registered nurse.

SOURCE: TX Admin Code Title 1, Sec. 354.2607, (Accessed Apr. 2025).

Mental Health Recovery Treatment Planning, Mental Health Targeted Case Management, Crisis Intervention Services, Medication Training and Support Services, Psychosocial Rehabilitative Services, Skills Training and Development Services

The aforementioned may be delivered as a telemedicine medical service or a telehealth service, including via an audio-only platform, in accordance with the requirements and limitations of Subchapter A, Division 33 of this chapter (relating to Advanced Telecommunications Services). See applicable Administrative Code section for more details.

SOURCE: TX Admin Code Title 1, Sec. 354.2609, TX Admin Code Title 1, Sec. 354.2655, TX Admin Code Title 1, Sec. 354.2707, TX Admin Code Title 1, Sec. 354.2709, TX Admin Code Title 1, Sec. 354.2711, TX Admin Code Title 1, Sec. 354.2713, (Accessed Apr. 2025).

Ongoing Evaluation and Management of Chronic Pain and Chronic Pain Management (CPM)

The first time that procedure code G3002 is billed, the physician or qualified health practitioner must see the client in person. After the initial visit, any of the CPM in-person components included in procedure codes G3002 and G3003 may be provided through telehealth, as clinically appropriate, to increase access to care for Medicaid clients.

SOURCE: TX Medicaid Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook, (Apr. 2025), pg. 175 (Accessed Apr. 2025).

Managed Care

MCOs may offer to STAR+PLUS members a choice of audio-visual communication in place of in-person change in condition assessments, as long as the assessment does not require or potentially require a change in the RUG level.

During a declared state of disaster, HHSC may issue direction to STAR+PLUS [STAR Kids and STAR Health] MCOs regarding whether initial, annual renewal, or change in condition assessments may be conducted through audio-visual or audio-only communication for STAR+PLUS members who reside in the area subject to the declared state of disaster.

For limited circumstances, STAR+PLUS [STAR Kids and STAR Health] MCOs may submit, in a manner and format prescribed by HHSC, an exceptions policy for required in-person assessments for approval by HHSC. The policy must be developed by the MCO’s clinical staff, such as the Chief Medical Director or the Director’s designee.

See rules Sec. 1604-1506 for additional requirements for each program.

SOURCE: TX Admin Code, Title 1, Part 15, Sec. 353.1503, (Accessed Apr. 2025).

Ambulance Services

Emergency Triage, Treat, Transport (ET3) permits emergency transportation (ground ambulance) providers to: … Initiate and facilitate appropriate TIP through telemedicine or telehealth.

Treatment on scene may also be performed, when medically necessary, via a telemedicine or telehealth visit performed in accordance with telemedicine and telehealth services requirements outlined in the Telecommunication Services Handbook (Vol. 2, Provider Handbooks).

When billing for TIP via telemedicine or telehealth, providers must bill using the most clinically appropriate emergency transport code (A0427 or A0429), the ET modifier, the W destination modifier to indicate TIP, and procedure code Q3014. Procedure code Q3014 will be informational only and used by Medicaid to identify TIP through telemedicine or telehealth services.

SOURCE: TX Medicaid Ambulance Services, (Apr. 2025). (Accessed Apr. 2025).

Emergency triage, treat and transport (ET3) services. HHSC may reimburse a Medicaid-enrolled ambulance provider responding to a call initiated by an emergency response system and upon arrival at the scene the ambulance provider determines the recipient’s needs are nonemergent, but medically necessary. ET3 services may be reimbursed for: …

initiating and facilitating treatment in place via telemedicine or telehealth.

SOURCE: TX Admin Code Sec. 354.1115, (Accessed Apr. 2025).

CSHCN Program

Emergency room care, critical care, home care, preventive care, newborn care, and care provided in a nursing home, skilled nursing facility, or client’s home, are not approved telemedicine or telehealth services. Consultative, but not routine, inpatient care, is included as a telemedicine or telehealth service.

Telemedicine is provided for the purpose of the following:

Client assessment by a health professional
Diagnosis, consultation, or treatment by a physician
Transfer of medical data that requires the use of advanced telecommunications technology, other than telephone or facsimile technology, including the following:
- Compressed digital interactive video, audio, or data transmission.
- Clinical data transmission using computer imaging by way of still-image capture and store-and-forward.
- Other technology that facilitates access to health-care services or medical specialty expertise.

See manual for specific codes.

SOURCE: TX Medicaid CSHCN Services Program Provider Manual: Telecommunication Services (Mar. 2025), p. 3-4. (Accessed Apr. 2025).

Inpatient Outpatient Hospital – Radiation Therapy

Teletherapy is covered by Texas Medicaid once per day in an outpatient hospital setting.

SOURCE: TX Medicaid Inpatient and Outpatient Hospital Services Handbook, p. 61 (Apr. 2025). (Accessed Apr. 2025).

Emergency Triage, Treat, and Transport (ET3)

Emergency Triage, Treat, and Transport (ET3) services are designed to allow greater flexibility for Medicaid-enrolled ambulance providers to address clients’ health-care needs following a 9-1-1 call, fire, police, or other locally established system for emergency calls. ET3 permits emergency transportation (ground ambulance) providers to: …

Initiate and facilitate appropriate TIP through telemedicine or telehealth.

Treatment in Place

Treatment on scene may also be performed, when medically necessary, through a telemedicine or telehealth visit performed in accordance with telemedicine and telehealth services requirements outlined in the Telecommunication Services Handbook (Vol. 2, Provider Handbooks).

Note: Similar section contained in CSHCN Ambulance Provider Manual.

SOURCE: TX Medicaid Ambulance Services, (Apr. 2025). (Accessed Apr. 2025).

Preventive care medical checkups are not a benefit of a telemedicine or telehealth service.

SOURCE: TX Medicaid CSHCN Services Program Manual – Physician, (Apr. 2025), (Accessed Apr. 2025).

Home Dialysis

Certain telemedicine and telehealth services may be provided for ESRD clients if clinically appropriate and safe, as determined by the provider, and agreed to by the person receiving services. Whenever possible, HHSC encourages face-to-face interactions, such as an in-person visit.

Documentation requirements for a telehealth service are the same as for an in-person visit and must accurately reflect the services rendered. Documentation must identify the means of delivery when provided.

See manual for ESRD dialysis services are authorized for telemedicine and telehealth delivery using synchronous audiovisual technology.

Services provided by synchronous audio-visual technology must be billed using modifier 95.

During a Declaration of State of Disaster, the Texas Health and Human Services Commission (HHSC) may issue direction to providers regarding the use of a telemedicine or telehealth services to include the use of a synchronous telephone (audio-only) platform to provide covered services outside of the allowances described herein to the extent permitted by Texas law. A Declaration of State of Disaster is when an executive order or proclamation is issued by the governor declaring a state of disaster in accordance with Section 418.014 of the Texas Government Code.

The Telecommunication Services Handbook (Vol. 2, Provider Handbooks) for more information about telemedicine and telehealth documentation requirements including requirements for informed consent.

SOURCE: TX Medicaid Clinic and Other Outpatient Facility Services Handbook, p. 26 (Apr. 2025). (Accessed Apr. 2025).

ECI Services

Face-to-face–The delivery of ECI services in-person or via telehealth.

SOURCE: TX Admin Code Title 26, Part 1, Ch. 350, Sec. 103, (Accessed Apr. 2025).

ELIGIBLE PROVIDERS

The information in this handbook is intended for home health agencies, hospitals, nurse practitioners (NP), clinical nurse specialists (CNS), certified nurse midwives (CNM), licensed professional counselors (LPC), licensed marriage and family therapists (LMFT), licensed clinical social workers (LCSW), physicians, physician assistants (PA), psychologists, licensed psychological associates, provisionally licensed psychologists, and licensed dieticians.

Providers may provide telecommunication services for Texas Medicaid clients under the provider’s National Provider Identifier (NPI). No additional enrollment is required to provide telemedicine medical service or telehealth services.

Telemedicine Services

A distant site is the location of the provider rendering the service. Distant-site telemedicine benefits include services that are performed by the following providers, who must be enrolled as a Texas Medicaid provider:

Physician
Clinical Nurse Specialist (CNS)
Nurse Practitioner (NP)
Physician Assistant (PA)
Certified Nurse Midwife (CNM)
Federally Qualified Health Center (FQHC) (in manual only)

A distant site provider is the physician, or PA, NP, CNM, FQHC, Rural Health Clinic (RHC), or CNS who is supervised by and has delegated authority from a licensed Texas physician, who uses telemedicine to provide health-care services to a client in Texas.

Distant site providers must be licensed in Texas.

An out-of-state physician who is a distant site provider may provide episodic telemedicine without a Texas medical license as outlined in Texas Occupations Code §151.056 and Title 22 Texas Administrative Code (TAC) §172.2(g)(4) and 172.12(f).

Distant site providers that provide mental health services must be appropriately licensed or certified in Texas, or be a qualified mental health professional-community services (QMHP-CS), as defined in 26 TAC §301.303(48).

School Based Services: Telemedicine services provided in a school-based setting are also a benefit if the physician delegates provision of services to a nurse practitioner, clinical nurse specialist, or physician assistant, as long as the nurse practitioner, clinical nurse specialist, or physician assistant is working within the scope of their professional license and within the scope of their delegation agreement with the physician.

SOURCE: TX Medicaid Telecommunication Services Handbook, p. 3-10 (Apr. 2025). (Accessed Apr. 2025).

Telehealth Services

A distant site is the location of the provider rendering the service. A distant site provider is the health professional licensed, certified, or otherwise entitled to practice in Texas who uses telehealth services to provide health care services to a patient in Texas.

Licensed psychological associates (LPAs), provisionally licensed psychologists (PLPs), post-doctoral psychology fellows, and pre-doctoral psychology interns under psychologist supervision may also deliver telehealth services. All requirements outlined in the Outpatient Mental Health Services benefit language must be met.

Distant site providers who provide mental health services must be appropriately licensed or certified in Texas or be a QMHP-CS as defined in 26 Texas Administrative Code §301.303(48).

A distant-site provider that is located outside of state lines while rendering services is considered an out-of-state provider.

The distant site provider must obtain informed consent to treatment from the patient, patient’s parent or the patient’s legal guardian prior to rendering a telehealth service.

Distant site providers should meet all other telehealth service requirements specified in Texas Occupations Code §111.

SOURCE: TX Medicaid Telecommunication Services Handbook, p. 12 (Apr. 2025). (Accessed Apr. 2025).

Eligible providers performing telemedicine medical, telehealth, or home telemonitoring services are defined in §354.1430 of this title (relating to Definitions), §354.1432 of this title (relating to Telemedicine and Telehealth Benefits and Limitations), and §354.1434 of this title (relating to Home Telemonitoring Benefits and Limitations).

The Health and Human Services Commission (HHSC) reimburses eligible distant site professionals providing telemedicine medical services as follows:

Physicians are reimbursed for their Medicaid telemedicine medical services in the same manner as their other professional services in accordance with §355.8085 of this title (relating to Reimbursement Methodology for Physicians and Other Practitioners).
Physician assistants are reimbursed for their Medicaid telemedicine medical services in the same manner as their other professional services in accordance with §355.8093 of this title (relating to Reimbursement Methodology for Physician Assistants).
Advanced Practice Registered Nurses (APRNs) are reimbursed for their Medicaid telemedicine medical services in the same manner as their other professional services in accordance with §355.8281 of this title (relating to Reimbursement Methodology for Nurse Practitioners and Clinical Nurse Specialists).
Certified nurse midwives are reimbursed for their Medicaid telemedicine medical services in the same manner as their other professional services in accordance with §355.8161 of this title (relating to Reimbursement Methodology for Midwife Services).

HHSC reimburses eligible distant site professionals providing telehealth services as follows:

Licensed professional counselors, including licensed marriage and family therapists, and licensed clinical social workers (including Comprehensive Care Program social workers) are reimbursed for their Medicaid telehealth services in the same manner as their other professional services in accordance with §355.8091 of this title (relating to Reimbursement to Licensed Professional Counselors, Licensed Clinical Social Workers, and Licensed Marriage and Family Therapists).
Licensed psychologists (including licensed psychological associates) and psychology groups are reimbursed for their Medicaid telehealth services in the same manner as their other professional services in accordance with §355.8085 of this title.
Durable medical equipment suppliers are reimbursed for their Medicaid telehealth services in the same manner as their other professional services in accordance with §355.8023 of this title (relating to Reimbursement Methodology for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS)).

HHSC reimburses eligible providers performing home telemonitoring services in the same manner as their other professional services described in §355.8021 of this title (relating to Reimbursement Methodology for Home Health Services).

SOURCE: TX Admin Code. Title 1, Sec. 355.7001 (Accessed Apr. 2025).

School Health and Related Services (SHARS)

LEAs that participate in the SHARS program may be reimbursed for telehealth and telemedicine services delivered to children in school-based settings, or while receiving remote instruction.

See manual for specific requirements.

LEAs that participate in the SHARS program may be reimbursed for telehealth occupational therapy (OT), physical therapy (PT), speech therapy (ST), counseling, and psychological services.

All other reimbursement and billing guidelines that are applicable to in-person services will also apply when OT, PT, ST, counseling, and psychological services are delivered as telehealth services.

See manual for procedure codes and requirements that may be provided to children eligible through SHARS as telehealth services via synchronous audiovisual technology if clinically appropriate (as determined by the treating provider), safe and agreed to by the student receiving services.

SOURCE: TX Medicaid School Health and Related Services (SHARS) Handbook, (Apr. 2025). (Accessed Apr. 2025).

School-based telemedicine medical services. If a telemedicine medical service provided by an out-of-network physician to a member in a primary or secondary school-based setting meets the conditions for reimbursement in §354.1432 of this title (relating to Telemedicine and Telehealth Benefits and Limitations), a health care MCO must reimburse the out-of-network physician without prior authorization, even if the physician is not the member’s primary care provider. The MCO must use the reasonable reimbursement methodology described in subsection (f)(2) of this section to reimburse an out-of-network physician.

SOURCE: TX Admin Code Title 1, Sec. 353.4, (Accessed Dec. 2025).

FQHCS

FQHCs may be reimbursed the distant-site provider fee for telemedicine services at the Prospective Payment System (PPS) rate or Alternative Prospective Payment System (APPS) rate.

FQHC practitioners may be employees of the FQHC or contracted with the FQHC.

SOURCE: TX Medicaid Telecommunication Services Handbook, p. 10 & 12 (Apr. 2025). (Accessed Apr. 2025).

After the first encounter, the patient suffers illness or injury requiring additional diagnosis or treatment; or
The FQHC patient has a medical visit and an “other” health visit, as defined in paragraph (13) of this subsection.

SOURCE: Texas Admin Code Title 1, Sec. 355.8261, (Accessed Apr. 2025).

Rural Health Clinics

RHCs may be reimbursed the distant-site provider fee for telemedicine services at the PPS rate. RHC practitioners may be employees of the RHC or contracted with the RHC.

The facility fee (procedure code Q3014) may be reimbursed as an add-on procedure code that should not be included in any cost reporting that is used to calculate the RHC AIR (All Inclusive Rate) PPS per visit encounter rate.

To receive reimbursement for more than one facility fee for the same client on the same date of service, an RHC must submit documentation of medical necessity that the client needed multiple distant-site provider consultations. An RHC can use a signed letter from the client’s treating health care provider at the RHC documenting that the client suffered an illness or injury requiring additional diagnosis or treatment by a distant site provider. This will suffice to document the client’s medical need for purposes of receiving additional facility fee payments for the same client on the same date of service. The letter must state that the client suffered an illness or injury that required additional diagnosis or treatment by a distant-site provider.

If an RHC is eligible for payment of both an encounter fee and a facility fee for the same client on the same date of service, the RHC must submit a claim for the facility fee separate from the claim submitted for the encounter.

The facility fee should not be included in any cost reporting that is used to calculate the RHC All Inclusive Rate (AIR) prospective payment system (PPS) per-visit encounter rate.

Note: Telemedicine and telehealth services must be billed with modifier 95. Procedure codes that indicate remote delivery (telemedicine medical services or telehealth services) in the description do not need to be billed with modifier 95.

SOURCE: TX Medicaid Telecommunication Services Handbook, p. 11 (Apr. 2025). (Accessed Apr. 2025).

A medical visit is a face-to-face or telemedicine medical service encounter between an RHC patient and a physician, physician assistant, advanced nurse practitioner, certified nurse-midwife, visiting nurse, or clinical nurse practitioner. Encounters with more than one health professional and multiple encounters with the same health professional that take place on the same day and at a single location constitute a single visit, except where one of the following conditions exists:

after the first encounter, the patient suffers illness or injury requiring additional diagnosis or treatment; or
the RHC patient has a medical visit and an “other” health visit as defined in subsection (n) of this section.

An “other” health visit includes, but is not limited to, a face-to-face or telehealth service encounter between an RHC patient and a clinical social worker.

SOURCE: 15 TAC Sec. 355.8101. (Accessed Apr. 2025).

Physical Therapy, Occupational Therapy, and Speech and Language Pathology as a Telehealth Service.

SOURCE: 26 TAC Sec. 263.9, (Accessed Dec. 2025).

CSHCN Program

A distant site is the location of the provider rendering the service. Distant-site benefits include services that are performed by the following providers, who must be enrolled as a CSHCN Services Program provider:

Telemedicine Services

Physician
Advanced Practice Registered Nurse (APRN)
Physician assistant (PA)

Telehealth Services

Licensed professional counselor
Licensed marriage and family therapist
Licensed clinical social worker
Psychologist
Licensed dietician

See manual for other specific requirements.

SOURCE: TX Medicaid CSHCN Telecommunication Services Handbook, p. 5 & 8 (Mar. 2025). (Accessed Apr. 2025).

Providers of CFP services must defer to the needs of the parent(s), LAR(s), or primary caregiver(s) receiving the services, allowing the mode of service delivery to be accessible and family centered, and primarily driven by the parent’, LARs’, or primary caregivers’ choice and not provider convenience.

Providers must provide CFP services to the parent(s), LAR(s), or primary caregiver(s) of the Medicaid eligible child or youth in accordance with accepted medical community standards and standards that govern occupations, as explained in Title 1 TAC §371.1659. In addition, providers must deliver, to include delivery by telemedicine or telehealth, CFP services in full accordance with all applicable licensure and certification requirements.

CFP services may be provided by synchronous audiovisual technology if clinically appropriate and safe, as determined by the billing provider, and agreed to by the parent(s), LAR(s), or primary caregiver(s) receiving services. In addition, approval to deliver the services by synchronous audiovisual technology must be documented in the plan of care of the Medicaid eligible child or youth receiving services. CFP services provided by synchronous audiovisual technology must be billed using modifier 95.

SOURCE: TX Behavioral Health and Case Management Services Handbook, Pg. 86, (Apr. 2025), (Accessed Apr. 2025).

ELIGIBLE SITES

The physical environments of the client and the distant site provider must ensure that the client’s protected health information remains confidential. A parent or legal guardian may be physically located in the patient site or distant site environment during a telehealth or telemedicine service with a child.

A patient site is the place where the client is physically located. A client’s home may be the patient site for telemedicine.

A patient site is the place where the client is physically located while the service is rendered. Patient-site providers that are enrolled in Texas Medicaid may only be reimbursed for the facility fee using procedure code Q3014. Charges for other services that are performed at the patient site may be submitted separately.

A client’s home may be the patient site for telehealth. Procedure code Q3014 is not a benefit if the patient site is the client’s home.

SOURCE: TX Medicaid Telecommunication Services Handbook, p. 10-13 (Apr. 2025). (Accessed Apr. 2025).

School-Based Setting

Conditions for telemedicine medical services provided in a primary or secondary school-based setting.

For a child receiving telemedicine medical services in a primary or secondary school-based setting, advance parent or legal guardian consent for a telemedicine medical service must be obtained.

The patient’s primary care physician or provider must be notified of a telemedicine medical service, unless the patient does not have a primary care physician or provider. (i) The patient receiving the telemedicine medical service, or the patient’s parent or legal guardian, must consent to the notification. (ii) For a telemedicine medical service provided to a child in a primary or secondary school-based setting, the notification must include a summary of the service, including:

Exam findings;
Prescribed or administered medications; and
Patient instructions.

See Administrative Code Section for more details.

SOURCE: TX Admin Code Title 1, Sec. 354.1432, (Accessed Apr. 2025).

Behavioral Health

CFP services may be provided in an office, home, outpatient hospital, other locations, and by telehealth if certain conditions are met.

SOURCE: TX Behavioral Health and Case Management Services Handbook, Pg. 86, (Apr. 2025), (Accessed Apr. 2025).

Telemedicine provided in a school-based setting by a physician, even if the physician is not the client’s primary care physician or provider, are benefits if all of the following criteria are met:

The physician is an authorized health-care provider enrolled in Texas Medicaid.

The client is a child who is receiving the service in a primary or secondary school-based setting.

The parent or legal guardian of the client provides consent before the service is provided.

Telemedicine services provided in a school-based setting are also a benefit if the physician delegates provision of services to a nurse practitioner, clinical nurse specialist, or physician assistant, as long as the nurse practitioner, clinical nurse specialist, or physician assistant is working within the scope of their professional license and within the scope of their delegation agreement with the physician.

SOURCE: TX Medicaid Telecommunication Services Handbook, p. 10 (Apr. 2025). (Accessed Apr. 2025).

Telemedicine medical services provided in a school-based setting by a physician, even if the physician is not the patient’s primary care physician, will be reimbursed in accordance with the applicable methodologies described in subsection (b)(1) of this section and §355.8443 of this title (relating to Reimbursement Methodology for School Health and Related Services (SHARS)) if the following conditions are met:

the physician is an authorized health care provider under Medicaid;
the patient is a child who receives the service in a primary or secondary school-based setting;
the parent or legal guardian of the patient provides consent before the service is provided; and
a health professional as defined by Texas Government Code §548.0101 is present with the patient during the treatment.

SOURCE: TX Admin. Code, Title 1, Sec. 355.7001(f). (Accessed Apr. 2025).

School Health and Related Services (SHARS)

LEAs that participate in the SHARS program may be reimbursed for telehealth and telemedicine services delivered to children in school-based settings, or while receiving remote instruction.

OT, PT, ST, counseling, and psychological telehealth services provided by LEAs during school hours through SHARS may be delivered via synchronous audiovisual technologies.

The patient site must be a school, home, or community-based setting in order for the distant site provider to be eligible for reimbursement of these services.

SOURCE: TX Medicaid School Health and Related Services (SHARS) Handbook, (Apr. 2025). (Accessed Apr. 2025).

CSHCN Program

A patient site is where the client is physically located while the service is rendered. The patient-site must be one of the following:

Established medical site – A location where clients will present to seek medical care. There must be a patient-site presenter and sufficient technology and medical equipment to allow for an adequate physical evaluation, as appropriate for the client’s presenting complaint. A defined physician-client relationship is required. A client’s private home is not considered an established medical site.

Established health site – A location where clients will present to seek a health service. There must be a patient-site presenter and sufficient technology and medical equipment to allow for an adequate physical evaluation or assessment, as appropriate for the client’s presenting complaint. A defined health provider-client relationship is required. A client’s private home is not considered an established health site.

SOURCE: TX Medicaid CSHCN Telecommunication Services Handbook, (Mar. 2025). (Accessed Apr. 2025).

GEOGRAPHIC LIMITS

No Reference Found

FACILITY/TRANSMISSION FEE

Patient-site providers that are enrolled in Texas Medicaid may only be reimbursed for the facility fee using procedure code Q3014. Procedure code Q3014 is payable to NP, CNS, PA, physicians, and outpatient hospital providers. Charges for other services that are performed at the patient site may be submitted separately. Procedure code Q3014 is not a benefit if the patient site is the client’s home.

Telemedicine Services for FQHCs

FQHCs may be reimbursed the facility fee (procedure code Q3014) as an add-on procedure code that should not be included in any cost reporting that is used to calculate a PPS or APPS per visit encounter rate.

To receive reimbursement for more than one facility fee for the same client on the same date of service, an FQHC must submit documentation of medical necessity that indicates that the client needed multiple distant-site provider consultations. An FQHC can use a signed letter from the client’s treating health- care provider at the FQHC to document the client’s medical need for receiving multiple distant-site provider consultations on the same date of service. The letter must state that the client suffered an illness or injury that required additional diagnosis or treatment by a distant-site provider.

If an FQHC is eligible for payment of both an encounter fee and a facility fee for the same client on the same date of service, the FQHC must submit a claim for the facility fee separate from the claim that was submitted for the encounter.

Telemedicine Services for RHCs

The facility fee should not be included in any cost reporting that is used to calculate the RHC All Inclusive Rate (AIR) prospective payment system (PPS) per-visit encounter rate.

Distant-Site Telehealth Services for FQHCs

The facility fee (procedure code Q3014) may be reimbursed as an add-on procedure code and should not be included in any cost reporting that is used to calculate a PPS or APPS per visit encounter rate.

To receive reimbursement for more than one facility fee for the same client on the same date of service, an FQHC must submit documentation of medical necessity indicating that the client needed multiple distant site provider consultations.

An FQHC can use a signed letter from the client’s treating health care provider at the FQHC documenting that the client suffered an illness or injury requiring additional diagnosis or treatment by a distant site provider. This will suffice to document the client’s medical need for purposes of receiving additional facility fee payments for the same client on the same date of service.

If an FQHC is eligible for payment of both an encounter and a facility fee for the same client on the same date of service, the FQHC must submit claims for the facility fee separate from claims submitted for the encounter.

Distant-Site Telehealth Services for RHCs

RHCs may be reimbursed the distant-site provider fee for telehealth services at the PPS rate.

RHC practitioners may be employees of the RHC or contracted with the RHC.

To receive reimbursement for more than one facility fee for the same client on the same date of service, an RHC must submit documentation of medical necessity indicating that the client needed multiple distant site provider consultations.

A signed letter from the client’s treating health care provider at the RHC documenting that the client suffered an illness or injury requiring additional diagnosis or treatment by a distant site provider will suffice to document the client’s medical need for purposes of receiving additional facility fee payments for the same client on the same date of service.

If an RHC is eligible for payment of both an encounter and a facility fee for the same client on the same date of service, the RHC must submit claims for the facility fee separate from claims submitted for the encounter.

SOURCE: TX Medicaid Telecommunication Services Handbook, p. 13 (Apr. 2025). (Accessed Apr. 2025).

Telemedicine and telehealth patient site locations, as defined in §354.1430 and §354.1432 of this title, are reimbursed a facility fee determined by HHSC.

SOURCE: TX Admin. Code, Title 1 Sec. 355.7001(d), (Accessed Apr. 2025).

Healthy Texas Women Program

FQHCs and RHCs may be reimbursed for telemedicine and telehealth in the following manner: …

The facility fee (procedure code Q3014) is an add-on procedure code that should not be included in any cost reporting that is used to calculate a FQHC PPS, APPS, or the RHC AIR (All Inclusive Rate) PPS per visit encounter rate.

SOURCE: TX Medicaid Healthy Texas Women Program Handbook, (Apr. 2025), pg. 13 (Accessed Apr. 2025).

CSHCN Program

Patient-site providers enrolled in the CSHCN Services Program may only be reimbursed for the facility fee using procedure code Q3014. Procedure code Q3014 is payable to advanced practice registered nurses, physician assistants, and physicians in the office and outpatient hospital settings and to hospitals in the outpatient hospital setting. Charges for other services that are performed at the patient site may be submitted separately.

Procedure code Q3014 is not a benefit if the patient site is the client’s home.

The facility fee (procedure code Q3014) is not a benefit for telehealth services. Charges for other services that are performed at the patient site may be submitted separately.

SOURCE: TX Medicaid CSHCN Telecommunication Services Handbook, p. 6, 7, 9 (Mar. 2025). (Accessed Apr. 2025).

Treatment in Place

SOURCE: TX Medicaid Ambulance Services, (Apr. 2025). pg. 7-8 (Accessed Apr. 2025).

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