Texas

Disclaimer

PLEASE NOTE: CCHP is providing the following for informational purposes only. We are not providing legal advice or interpretation of the laws and regulations and policies. CCHP encourages you to check with the appropriate state agency for further information and direction. This information should not be construed as legal counsel. Consult with an attorney if you are seeking a legal opinion.

At A Glance
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MEDICAID REIMBURSEMENT

  • Live Video: Yes
  • Store-and-Forward: Yes
  • Remote Patient Monitoring: Yes
  • Audio Only: Yes

PRIVATE PAYER LAW

  • Law Exists: Yes
  • Payment Parity: No

PROFESSIONAL REQUIREMENTS

  • Licensure Compacts: EMS, IMLC, NLC, PSY, PTC
  • Consent Requirements: Yes

FQHCs

  • Originating sites explicitly allowed for Live Video: Yes
  • Distant sites explicitly allowed for Live Video: Yes
  • Store and forward explicitly reimbursed: No
  • Audio-only explicitly reimbursed: No
  • Allowed to collect PPS rate for telehealth: Yes

STATE RESOURCES

  1. Medicaid Program: Texas Medicaid
  2. Administrator: Texas Health and Human Services Commission
  3. Regional Telehealth Resource Center: TexLa Telehealth Resource Center
Disclaimer

PLEASE NOTE: CCHP is providing the following for informational purposes only. We are not providing legal advice or interpretation of the laws and regulations and policies. CCHP encourages you to check with the appropriate state agency for further information and direction. This information should not be construed as legal counsel. Consult with an attorney if you are seeking a legal opinion.

Last updated 09/07/2022

Audio-Only Delivery

Medicaid: Provider Information

STATUS: Active, various expiration dates.

Medicaid: COVID-19 Extension for multiple Flexibilities

STATUS: Active

Medicaid:Telemedicine (Physician-Delivered) and Telehealth (Non-Physician-Delivered) Services Extended through January 21, 2021, or through January 31, 2021 if the PHE is Extended

STATUS: Expired

Medicaid: FQHC Reimbursement for Telemedicine and Telehealth Services

STATUS: Permanent

Medicaid: RHC Reimbursement for Telemedicine and Telehealth Services

STATUS: Permanent

Medicaid: Telephone Early Childhood Intervention Specialized Skills Training

STATUS: Expires when the federal PHE ends.

Medicaid: Telephone Nutritional Counseling Services

STATUS: Expires when the federal PHE ends.

Medicaid: Telephone for Behavioral Health Services

STATUS: Expires Apr. 30, 2022.  See Interim Guidance.

Medicaid: Telephone for Medical Services

STATUS: Expired

Medicaid 1915(c) Waiver: Appendix K – Texas Home Living (TxHmL) and Home and Community-based Services (HCS)

STATUS:  Active, expires at end of PHE. See Addendum

Medicaid 1915(c) Waiver: Appendix K- Texas Home Living (TxHmL) and Home and Community-based Services (HCS)

STATUS: Addendum, Active until end of PHE

Medicaid 1915(c) Waiver: Appendix K – Youth Empowerment Services (YES)

STATUS: Active, expires at end of PHE. See Addendum

Medicaid 1915(c) Waiver: Appendix K- Youth Empowerment Services (YES)

STATUS: Addendum, Active until end of PHE

Medicaid 1915(c) Waiver: Appendix K – Deaf Blind with Multiple Disabilities (DBMD) and Community Living Assistance and Support Services (CLASS)

STATUS: Active, expires at end of PHE. See Addendum

Medicaid 1915(c) Waiver: Appendix K- Deaf Blind with Multiple Disabilities (DBMD) and Community Living Assistance and Support Services (CLASS)

STATUS: Addendum, Active until end of PHE

Medicaid 1915(c) Waiver: Appendix K – Medically Dependent Children Program (MDCP)

STATUS: Active, expires at end of PHE. See Addendum

Medicaid 1915(c) Waiver: Appendix K- Medically Dependent Children Program (MDCP)

STATUS: Addendum, Active until end of PHE

Texas Health and Human Services Commission: Behavioral Health Services Providers FAQs

STATUS: Active

Texas Health and Human Services Commission: Chemical Dependency Treatment Facility Requirements During the COVID-19 Pandemic 

STATUS: Expired

Last updated 09/07/2022

Cross State Licensing

Texas Medical Board: Licensing for Out-of-State Providers

STATUS: Active

Last updated 09/07/2022

Easing Prescribing Requirements

Medical Board: FAQs Regarding Telemedicine during COVID-19

STATUS: Varies

Medical Board:  Treatment of Chronic Pain

STATUS: Permanent

Last updated 09/07/2022

Miscellaneous

Board of Nursing: Telehealth FAQs

STATUS: Active

Medicaid 1915(c) Waiver: Extension of Waivers

STATUS: Expires at end of PHE.

Last updated 09/07/2022

Originating Site

Medicaid: Provider Information

STATUS: Active, various expiration dates.

Medicaid: COVID-19 Extension for multiple Flexibilities

STATUS: Active, various expiration dates.

Health and Human Services Commission: ESRD visits via Telehealth

STATUS: Expired

 

Last updated 09/07/2022

Private Payer

Department of Insurance: Worker’s Compensation Provider Information on Telemedicine

STATUS: Active

Department of Insurance: Emergency Rule FAQs

STATUS: Varies

Department of Insurance: MMI and IR evaluations not allowed via telemedicine and telehealth

STATUS: Permanent

Last updated 09/07/2022

Provider Type

Medicaid: Provider Information

STATUS: Active, various expiration dates.

Texas Health and Human Services Commission: Behavioral Health Services Providers FAQs

STATUS: Active

Medicaid: COVID-19 Extension for multiple Flexibilities

STATUS: Active, various expiration dates.

Medicaid: Permanent FQHC Telehealth Reimbursement

STATUS: Effective February 28, 2021

Last updated 09/07/2022

Service Expansion

Medicaid: Provider Information

STATUS: Active, various expiration dates.

Medicaid: COVID-19 Extension for multiple Flexibilities

STATUS: Active

Medicaid: Telemedicine (Physician-Delivered) and Telehealth (Non-Physician-Delivered) Services Extended through January 21, 2021, or through January 31, 2021 if the PHE is Extended

STATUS: Expired

Medicaid: Flexibilities Extended for Claims for Telemedicine and Telehealth Services for HTW Plus

STATUS: Expires Apr. 30, 2022. Replaced by Interim Guidance.

Medicaid: FQHC Reimbursement for Telemedicine and Telehealth Services

STATUS: Permanent

Medicaid: RHC Reimbursement for Telemedicine and Telehealth Services

STATUS: Permanent

Medicaid: SHARES Provided through Telemedicine or Telehealth

STATUS: Expires Apr. 30, 2022.  See interim guidance.

Medicaid: Telephone Early Childhood Intervention Specialized Skills Training

STATUS: Expires when the federal PHE ends.

Medicaid: Telephone Nutritional Counseling Services

STATUS: Expires when the federal PHE ends.

Medicaid: Health Steps Checkups

STATUS: Expires when the federal PHE ends.

Medicaid: Telephone for Behavioral Health Services

STATUS: Expires Apr. 30, 2022.  See Interim Guidance.

Medicaid: Telephone for Medical Services

STATUS: Expired

Health and Human Services Commission: ESRD visits via Telehealth

STATUS: Expired

Medicaid 1915(c) Waiver: Appendix K – Medically Dependent Children Program (MDCP)

STATUS: Active, expires at end of PHE. See Addendum

Medicaid 1915(c) Waiver: Appendix K- Medically Dependent Children Program (MDCP)

STATUS: Addendum, Active until end of PHE

Medicaid: Permanent FQHC Telehealth Reimbursement

STATUS: Effective February 28, 2021

Texas Health and Human Services Commission: Behavioral Health Services Providers FAQs

STATUS: Active

Last updated 09/07/2022

Definitions

“Telehealth service” means a health service, other than a telemedicine medical service, delivered by a health professional licensed, certified, or otherwise entitled to practice in this state 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.

“Telemedicine medical service” means a health care service delivered by a physician licensed in this state, or a health professional acting under the delegation and supervision of a physician licensed in this state, and acting within the scope of the physician’s or health professional’s license to a patient at a different physical location than the physician or health professional using telecommunications or information technology.

“Teledentistry dental service” means a health care service delivered by a dentist, or a health professional acting under the delegation and supervision of a dentist, acting within the scope of the dentist’s or health professional’s license or certification to a patient at a different physical location than the dentist or health professional using telecommunications or information technology.

SOURCE: TX Insurance Code Sec. 1455.001 (refers to Occupations Code Sec. 111.001). (Accessed Sept. 2022)

Workers Compensation Health Care Networks

Telehealth service, telemedicine medical service, and teledentistry dental service–Have the meanings assigned by Occupations Code §111.001, concerning Definitions.

SOURCE: TX Administrative Code Title 28, Part 1 Ch. 10, Rule 10.2 (Accessed Sept. 2022).

Last updated 09/07/2022

Parity

SERVICE PARITY

Prohibits a health benefit plan from excluding from coverage a covered health care service or procedure delivered by a preferred or contracted health professional to a covered patient as a telemedicine medical service, a teledentistry dental service, or a telehealth service solely because the covered health care service or procedure is not provided through an in-person consultation. A health benefit plan is not required to provide coverage for a telemedicine medical service, a teledentistry dental service, or a telehealth service provided by only synchronous or asynchronous audio interaction including audio-only telephone; email or facsimile.

SOURCE: TX Insurance Code 1455.004(a)  (Accessed Sept. 2022).


PAYMENT PARITY

No Reference Found

Last updated 09/07/2022

Requirements

A health benefit plan must provide coverage for a covered health care service or procedure delivered by a preferred or contracted health professional to a covered patient as a telemedicine medical service, teledentistry dental service, or telehealth service on the same basis and to the same extent that the plan provides coverage for the service or procedure in an in-person setting. They may not exclude from coverage a covered health care service or procedure delivered by a preferred or contracted health professional to a covered patient as a telemedicine medical service, a teledentistry dental service, or a telehealth service solely because the covered health care service or procedure is not provided through an in-person consultation.

Insurers may not limit, deny, or reduce coverage for a covered health care service or procedure delivered as a telemedicine medical service, teledentistry dental service, or telehealth service based on the health professional’s choice of platform for delivering the service or procedure.

SOURCE: TX Insurance Code Sec. 1455.004. (Accessed Sept. 2022).

Each issuer of a health benefit plan shall adopt and display in a conspicuous manner on the health benefit plan issuer’s Internet website the issuer’s policies and payment practices for telemedicine medical services, teledentistry dental services, and telehealth services.

SOURCE: TX Insurance Code Sec. 1455.006. (Accessed Sept. 2022).

Each evidence of coverage or certificate delivered or issued for delivery by an HMO may provide enrollees the option to access covered health care services through a telehealth service or telemedicine service.

SOURCE: Texas Admin Code, Title 28, Part 1, Ch. 11, Subchapter Q, Sec. 11.1607, (Accessed Sept. 2022).

Worker’s Compensation

A health care provider must bill for telemedicine and telehealth services according to Medicare payment policies as defined in Section 134.203 in the Texas Administrative Code; and provisions of the Texas Administrative Code, Insurance Title.  A health care provider may bill and be reimbursed or telemedicine or telehealth services regardless of where the injured employee is located at the time the telemedicine or telehealth services are provided.

SOURCE: TX Admin. Code, Title 28 Sec. 2.133.30 (Accessed Sept. 2022).

Recently Adopted Rule 

The State Board of Dental Examiners, in consultation with the commissioner of insurance, as appropriate, may adopt rules necessary to:

  • Ensure that patients using teledentistry dental services receive appropriate, quality care;
  • Prevent abuse and fraud in the use of teledentistry dental services, including rules relating to the filing of claims and records required to be maintained in connection with teledentistry dental services;
  • Ensure adequate supervision of health professionals who are not dentists and who provide teledentistry dental services under the delegation and supervision of a dentist; and
  • Authorize a dentist to simultaneously delegate to and supervise through a teledentistry dental service not more than five health professionals who are not dentists.

SOURCE: TX Occupational Code Title 3, Subtitle A, Chapter 111, Sec. 111.004.  (Accessed Sept. 2022).

Last updated 09/07/2022

Definitions

Teledentistry

“Teledentistry dental service” means a health care service delivered by a dentist, or a health professional acting under the delegation and supervision of a dentist, acting within the scope of the dentist’s or health professional’s license or certification to a patient at a different physical location than the dentist or health professional using telecommunications or information technology.

SOURCE: Insurance Code Title 8, Subtitle F, Ch. 1455.001 refers to Occupations Code, Sec. 111.001. (Accessed Sept. 2022).

“Telehealth service” means a health service, other than a telemedicine medical service, delivered by a licensed or certified health professional acting within the scope of the health professional’s license or certification who does not perform a telemedicine medical service and that requires the use of advanced telecommunications technology, other than telephone or facsimile technology, including:

  • Compressed digital interactive video, audio, or data transmission;
  • Clinical data transmission using computer imaging by way of still-image capture and store-and-forward; and
  • Other technology that facilitates access to health care services or medical specialty expertise.

“Telemedicine medical service” means a health care service, initiated by a physician or provided by a health professional acting under physician delegation and supervision, that is provided for purposes of patient assessment by a health professional, diagnosis or consultation by a physician, or treatment, or for the transfer of medical data, and that requires the use of advanced telecommunications technology, other than telephone or facsimile technology, including:

  • Compressed digital interactive video, audio, or data transmission;
  • Clinical data transmission using computer imaging by way of still-image capture and store-and-forward; and
  • Other technology that facilitates access to health care services or medical specialty expertise.

SOURCE: TX Admin. Code, Title 1 Sec. 354.1430 (Accessed Sept. 2022).

 “Telehealth service” means a health service, other than a telemedicine medical service or a teledentistry dental service, delivered by a health professional licensed, certified, or otherwise entitled to practice in this state 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.

“Telemedicine medical service” means a health care service delivered by a physician licensed in this state, or a health professional acting under the delegation and supervision of a physician licensed in this state, and acting within the scope of the physician’s or health professional’s license to a patient at a different location than the physician or health professional using telecommunications or information technology.

SOURCE: TX Government Code, Sec. 531.001 refers to Occupations Code, Sec. 111.001. (Accessed Sept. 2022)

Texas Medicaid managed care organiziations (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.

SOURCE: TX Medicaid Telecommunication Services Handbook,  Sept. 2022, p. 5 (Accessed Sept. 2022).

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 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.

SOURCE: TX Medicaid Telecommunication Services Handbook, p. 7 & 12 (Sept. 2022). (Accessed Sept. 2022).

Standards of Care in Crisis Stabilization Units

Telehealth service–A health-care service, other than telemedicine medical services, 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 an individual at a different physical location other than the health professional using telecommunications or information technology.

SOURCE: TX Admin Code, Title 26, Part 1, Ch. 306, Subchapter B, Sec. 306.45, (Accessed Sept. 2022).

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.

SOURCE:  TX Medicaid Telecommunication Services Handbook, p. 5 (Sept. 2022), (Accessed Sept. 2022).

Last updated 09/07/2022

Email, Phone & Fax

Conditions for reimbursement applicable to behavioral health services provided using a synchronous audio-only technology platform are those that meet the following conditions:

  • Must be designated for reimbursement by HHSC.
  • Provider must obtain informed consent from the client, client’s parent, or the client’s legally authorized representative prior to rendering a behavioral
  • health service through a synchronous audio-only technology platform; except when doing so is not feasible or could result in death or injury to the client. Verbal consent is permissible and must be documented in the client’s medical record.
  • 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 audio-only technology platform to receive reimbursement for the service.
  • Other conditions for reimbursement applicable to behavioral health services may vary by service type. Providers may refer to the appropriate TMPPM handbook for additional information on audio-only coverage conditions.

Conditions for reimbursement applicable to non-behavioral health services provided using a synchronous audio-only technology platform:

  • Must be designated for reimbursement by HHSC.
  • Clinically effective and cost-effective, as determined and published 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 audio-only technology platform to receive reimbursement for the service.

Note: Behavioral or non-behavioral health services that HHSC has determined are clinically effective and cost-effective when provided via a synchronous audio-only technology platform can be found in the appropriate TMPPM handbooks.

Procedure codes that are reimbursed to distant site providers when billed with the 93 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 93 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 telemedicine services.

SOURCE: TX Medicaid Telecommunication Services Handbook, pg. 7, 9, & 12 (Sept. 2022). (Accessed Sept. 2022).

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
  • 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

A Texas Medicaid Managed Care organization (MCO) is not required to provide reimbursement for telemedicine services that are provided through the following methods:

  • A text-only email message
  • A facsimile transmission

Texas Medicaid MCOs may optionally provide reimbursement for telemedicine services that are provided through asynchronous audio-only technology, such as voice mail technology. Distant site providers should contact each MCO to determine whether an MCO provides reimbursement for a specified modality.

SOURCE: TX Medicaid Telecommunication Services Handbook, pg. 9 &13 (Sept. 2022). (Accessed Sept. 2022).

Outpatient Mental Health Services

The following outpatient mental health services may be provided by synchronous telephone (audio-only) technology to persons with whom the treating provider has an existing clinical relationship and, 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, as well as, the use of synchronous audiovisual 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.

  • Outpatient mental health services provided by synchronous telephone (audio-only) technology must be billed using modifier FQ.
  • 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

See manual for procedure codes

Mental Health Targeted Case Management (MHTCM) Services

Mental health targeted case management (MHTCM) services may be provided by synchronous telephone (audio-only) technology to persons with whom the treating provider has an existing clinical relationship and, if clinically appro- priate and safe, as determined by the provider, and agreed to by the person receiving services or LAR. In addition, approval to deliver the services by synchronous telephone (audio-only) technology must be documented in the plan of care of the person 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 telemedicine and telehealth services. Therefore, providers of MHTCM services must document in the person’s medical record the reason(s) for why services were delivered by synchronous telephone (audio-only) technology. MHTCM services provided by synchronous telephone (audio-only) technology must be billed using modifier FQ.

An existing clinical relationship occurs when a person has received at least one in-person or synchronous audiovisual MHTCM service from the same provider within the six months prior to the initial service delivered by synchronous telephone (audio-only) technology. The six-month requirement for at least one in-person or synchronous audiovisual service prior to the initial synchronous telephone (audio-only) service may not be waived. See manual for additional information.

Mental Health Rehabilitative Services

The following MHR services may be provided by by synchronous telephone (audio-only) technology to persons with whom the treating provider has an existing clinical relationship and if clini- cally appropriate and safe, as determined by the 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 telephone (audio-only) technology must be documented in the plan of care of the person 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 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. MHR services provided by synchronous telephone (audio-only) technology must be billed using modifier FQ. See manual for procedure codes and additional requirements.

  • Medication training and support
  • Skills training and development
  • Psychosocial rehabilitation services
  • Crisis intervention services

Synchronous telephone (audio-only) technology may only be used for crisis intervention services as a back-up mode of delivery only, meaning if the person who is in crisis, not the treating provider, is unwilling or has limited technological capabilities that prevent them from using a synchronous audiovisual platform at the time the crisis intervention services are delivered. Also, the existing clinical relationship requirement is waived.

Peer Specialist Services

Peer specialist services may be provided by synchronous telephone (audio-only) technology to persons with whom the peer specialist has an existing clinical relationship and if clinically appropriate and safe, as determined by the provider, and agreed to by the person receiving services. In addition, approval to deliver the services by synchronous telephone (audio-only) technology must be documented in the person-centered recovery plan of the person 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 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. Peer specialist services provided by synchronous telephone (audio-only) technology must be billed using modifier FQ.

An existing clinical relationship occurs when a person has received at least one in-person or synchronous audiovisual peer specialist service from the same provider within the six months prior to the initial service delivered by synchronous telephone (audio-only) technology. The six-month requirement for at least one in-person or synchronous audiovisual service prior to the initial synchronous telephone (audio-only) service may not be waived.

The provider is required to conduct at least one in-person or synchronous audiovisual peer specialist service every rolling 12 months from the date of the initial service delivered by synchronous telephone (audio-only) technology unless the person receiving services and the provider agree that an in-person or synchronous audiovisual service is clinically contraindicated, or the risks or burdens of an in-person or synchronous audiovisual service outweigh the benefits. The decision to waive the 12- month requirement applies to that particular rolling 12-month period and the basis for the decision must be documented in the person’s medical record. Examples of when a synchronous telephone (audio-only) service may be more clinically appropriate or beneficial than an in-person or synchronous audiovisual service include, but are not limited to, the following:

  • The person receiving services is located at a qualifying originating site in an eligible geographic area, e.g., a practitioner office in a rural Health Professional Shortage Area.
  • An in-person or synchronous audiovisual service is likely to cause disruption in service delivery or has the potential to worsen the person’s condition.

See manual for additional information.

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

SBIRT services may be provided by synchronous telephone (audio-only) 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, as well as the use of synchronous audiovisual 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. SBIRT services provided by synchronous telephone (audio-only) technology must be billed using modifier FQ.  See manual for additional information.

Medication Assisted Treatment Services

The following SUD services may be provided by synchronous telephone (audio-only) technology to persons with whom the treating provider has an existing clinical relationship and 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, as well as the use of synchronous audiovisual 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. SUD services provided by synchronous telephone (audio-only) technology must be billed using modifier FQ.

  • Comprehensive assessment (procedure code H0001) – Only during certain public health emergencies or natural disasters; to the extent allowed by federal law (assessments for withdrawal management services are excluded); and the existing clinical relationship requirement is waived.
  • Individual and group counseling (procedure codes H0004 and H0005)

See manual for additional requirements.

SOURCE: TX Medicaid Behavioral Health and Case Management Services Handbook, pgs. 31, 49-50, 59, 72-73, 80-81, & 89,  (Sept. 2022). (Accessed Sept. 2022).

A cardiac rehabilitation program in which the cardiac monitoring is done using telephonically transmitted electrocardiograms (ECGs) to a remote site is not a benefit of Texas Medicaid.

SOURCE: TX Medicaid Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook, pg. 65. (Sept. 2022). (Accessed Sept. 2022).

To the extent permitted by state and federal law and to the extent it is cost-effective and clinically effective, as determined by the commission, the executive commissioner by rule shall develop and implement a system that ensures behavioral health services may be provided using an audio-only platform consistent with Section 111.008, Occupations Code, to a Medicaid recipient, a child health plan program enrollee, or another individual receiving those services under another public benefits program administered by the commission or a health and human services agency.

If the executive commissioner determines that providing services other than behavioral health services is appropriate using an audio-only platform under a public benefits program administered by the commission or a health and human services agency, in accordance with applicable federal and state law, the executive commissioner may by rule authorize the provision of those services under the applicable program using the audio-only platform. In determining whether the use of an audio-only platform in a program is appropriate under this subsection, the executive commissioner shall consider whether using the platform would be cost-effective and clinically effective.

SOURCE: TX Government Code Title 4, Subtitle I, Chapter 531, Subchapter A, Sec. 531.02161. (Accessed Sept. 2022).

Telehealth Exclusions

Any PT, OT, ST, and SST services delivered through synchronous telephone (audio-only) technology is not a benefit.

During a Declaration of State of Disaster, HHSC may issue direction to providers regarding the use of a 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.

See Children’s Services Handbook for a list of procedure codes that are in-person only and will not be reimbursed if provided through telehealth delivery.

Health and Behavior Assessment and Intervention

HBAI services may be provided by synchronous telephone (audio-only) 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, as well as the use of synchronous audiovisual 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. HBAI services provided by synchronous telephone (audio-only) technology must be billed using modifier FQ. See manual for eligible services and additional requirements.

Medical Nutrition Counseling Services (CCP)

Procedure code S9470 may be authorized for delivery using synchronous telephone (audio-only) technologies during a Declaration of State of Disaster. Services delivered using audio-only technologies must be billed using modifier 93.

Whenever possible, HHSC encourages face-to-face interaction, 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.

Medical Checkups During a Declaration of State Disaster

During a Declaration of State Disaster, Health and Human Services Commission (HHSC) may issue direction to providers regarding the use of telemedicine or telehealth services to include the use of synchronous telephone (audio-only) platform to provide coverage of 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.

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.

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.

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

SOURCE:  TX Medicaid Children’s Services Handbook, pgs. 57, 67, 71 & 186-187, (Sept. 2022), (Accessed Sept. 2022).

Synchronous audio-only, also called synchronous telephone (audio-only), technology – An interactive, two-way audio telecommunications platform, including telephone technology, that uses only sound and meets the privacy requirements of the Health Insurance Portability and Accountability Act.

Procedure codes that are reimbursed to distant site providers when billed with the 93 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 93 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.

SOURCE: TX Medicaid Telecommunication Services Handbook, pgs. 6, 9 and 12 (Sept. 2022). (Accessed Sept. 2022).

Last updated 09/07/2022

Live Video

POLICY

Synchronous audiovisual technology between the distant site provider and the client in another location is reimbursable under Texas Medicaid fee-for-service.

SOURCE: TX Medicaid Telecommunication Services Handbook, p. 13 (Sept. 2022) (Accessed Sept. 2022).

The executive commissioner by rule shall develop and implement a system to reimburse providers of services under Medicaid for services performed using telemedicine medical services, teledentistry dental services, or telehealth services.

SOURCE: TX Govt. Code Sec. 531.0216. (Accessed Sept. 2022).

Provider reimbursement for telemedicine services must be at the same rate as Medicaid reimburses for the same in-person medical service.  A request for reimbursement may not be denied solely because an in-person medical service between a physician and a patient did not occur.  The commission may not limit a physician’s choice of platform for providing a telemedicine medical service or telehealth service by requiring that the physician use a particular platform to receive reimbursement for the service.

SOURCE: TX Govt. Code Sec. 531.0217(d). (Accessed Sept. 2022).

Texas Medicaid managed care organiziations (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 receiving telemedicine services. 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).

The valid practitioner-patient relationship can be established through 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, Sept. 2022, p. 5, 7 & 8 (Accessed Sept. 2022).

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
  • 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, pg. 7, 9, & 13, (Sept. 2022). (Accessed Sept. 2022).

Eligible distant site providers are reimbursed in the same manner as their other professional services.  See administrative code for each provider type and the reference for the code under which TX Medicaid pays in the same manner of.

SOURCE: TX Admin. Code, Title 1 Sec. 355.7001, (Accessed Sept. 2022).

Telemedicine:  Texas health and human services agencies that administer a part of Medicaid are required to provide Medicaid reimbursement for a telemedicine service initiated or provided by a physician. Reimbursement is provided only for a telemedicine medical service initiated or provided by a physician.

A request for reimbursement may not be denied solely because an in-person medical service between a physician and a patient did not occur. Medicaid cannot limit a physician’s choice of platform for providing a telemedicine or telehealth service by requiring the use of a particular platform to receive reimbursement.

Medicaid reimbursement is provided to a physician for a telemedicine medical service provided by the physician, even if the physician is not the patient’s primary care physician or provider, if:

  • The physician is an authorized health care provider under Medicaid;
  • The patient is a child who receives the services in a primary or secondary school-based setting; and
  • The parent or legal guardian of the patient provides consent before the services is provided.

SOURCE: TX Govt. Code Sec. 531.0217, (Accessed Sept. 2022)

Telehealth:  Before receiving a telehealth service, the patient must receive an initial evaluation for the same diagnosis or condition by a physician or other qualified healthcare professional licensed in Texas which can be performed in-person or as a telemedicine visit that conforms to 22 TAC Ch. 174.  A patient receiving telehealth services must be evaluated annually by a physician or other healthcare professional (in-person or via a telemedicine visit) to determine if the patient has a continued need for the service.  If the patient is receiving the telehealth services to treat a mental health diagnosis or condition, the patient is not required to receive an initial evaluation.

SOURCE: TX Admin. Code, Title 1, Sec. 354.1432(2) (Accessed Sept. 2022).


ELIGIBLE SERVICES/SPECIALTIES

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, pg. 6, (Accessed Sept. 2022).

Texas Medicaid reimburses for telemedicine and telehealth codes specified in the TX Medicaid Provider Procedures Manual. See individual manuals for reimbursable services provided through telehealth.

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.

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.

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) delivery in the description do not need to be billed with the 95 modifier.

SOURCE: TX Medicaid Telecommunication Services Handbook, p. 4, 6-7, 9, 11 & 12 (Sept. 2022). (Accessed Sept. 2022).

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.

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. (Sept. 2022). (Accessed Sept. 2022).

Telemedicine

Texas Medicaid reimburses for live video for the following services provided through telemedicine:

  • Consultations;
  • Office or other outpatient visits;
  • Psychiatric diagnostic interviews;
  • Pharmacologic management;
  • Psychotherapy;
  • Data transmission

SOURCE: TX Admin. Code, Title 1, Sec. 354.1432(1). (Accessed Sept. 2022).

To the extent permitted by federal law and to the extent it is cost-effective and clinically effective, as determined by the commission, the commission shall ensure that Medicaid recipients, child health plan program enrollees, and other individuals receiving benefits under a public benefits program administered by the commission or a health and human services agency, regardless of whether receiving benefits through a managed care delivery model or another delivery model, have the option to receive services as telemedicine medical services, telehealth services, or otherwise using telecommunications or information technology, including the following services:

  • preventive health and wellness services;
  • case management services, including targeted case management services;
  • subject to Subsection (c), behavioral health services;
  •  occupational, physical, and speech therapy services;
  • nutritional counseling services; and
  • assessment services, including nursing assessments under the following Section 1915(c) waiver programs:
    • the community living assistance and support services (CLASS) waiver program;
    • the deaf-blind with multiple disabilities (DBMD) waiver program;
    • the home and community-based services (HCS) waiver program; and
    • the Texas home living (TxHmL) waiver program.

SOURCE:  TX Statute Sec. 531.02161, (Accessed Sept. 2022).

The commission by rule shall require each health and human services agency that administers a part of the Medicaid program to provide Medicaid reimbursement for teledentistry dental services provided by a dentist licensed to practice dentistry in this state.

The commission shall require reimbursement for a teledentistry dental service at the same rate as the Medicaid program reimburses for the same in-person dental service. A request for reimbursement may not be denied solely because an in-person dental service between a dentist and a patient did not occur. The commission may not limit a dentist’s choice of platform for providing a teledentistry dental service by requiring that the dentist use a particular platform to receive reimbursement for the service.

SOURCE: TX Govt. Code Sec. 531.02172, (Accessed Sept. 2022)

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 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
  • 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.

Mental Health Targeted Case Management (MHTCM) Services

Mental health targeted case management (MHTCM) 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 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 audio-visual technology must be billed using modifier 95.

Mental Health Rehabilitative Services

The following MHR 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 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 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 appro- priate 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.

Medication Assisted Treatment Services

The following SUD 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. SUD services provided by synchronous audiovisual technology must be billed using modifier 95. See manual for procedure codes.

  • 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.

SOURCE:  TX Medicaid Behavioral Health and Case Management Svcs. Handbook, pgs. 31, 49, 59 & 72-73, 80 & 89 (Sept. 2022). (Accessed Sept. 2022).

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.

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)

Synchronous audio-visual technology may be provided using procedure code S9470 if clinically appropriate and safe, as determined by the provider, and agreed to by the client receiving services. Services provided by synchronous audio-visual technology must be billed using modifier 95.

Medical Checkups During a Declaration of State Disaster

During a Declaration of State Disaster, Health and Human Services Commission (HHSC) may issue direction to providers regarding the use of telemedicine or telehealth services to include the use of synchronous telephone (audio-only) platform to provide coverage of 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.

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.

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.

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

SOURCE:  TX Medicaid Children’s Services Handbook, pgs. 56-57, 66, 71,  186-187, (Sept. 2022), (Accessed Sept. 2022).

Treatment of a client for chronic pain with scheduled drugs using telemedicine is prohibited, as provided by 22 TAC §174.5(e). Chronic pain is defined in 22 TAC §170.2(2).

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, (Sept. 2022). (Accessed Sept. 2022).

Schools that participate in the SHARS program may be reimbursed for telehealth OT, ST, and Counseling services delivered to children in school-based settings.

SOURCE: TX Medicaid School Health and Related Services (SHARS) Handbook, pg. 23 (Sept. 2022). (Accessed Sept. 2022).

Pre-admission assessments for admission into a crisis stabilization unit can be conducted either in person or through telemedicine. The additional assessments needed for children and adolescents can also be done through telehealth or telemedicine medical services.

SOURCE: TX Admin Code, Title 26, Part 1 Ch. 306, Sec. 306.67, (Accessed Sept. 2022).

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 Sept. 2022).

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 Sept. 2022).

Physical Therapy, Occupational Therapy, and Speech Therapy

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
  • 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 (Sept. 2022). (Accessed Sept. 2022).


ELIGIBLE PROVIDERS

Telemedicine Services

  • Telemedicine eligible distant site providers are enrolled as a Texas Medicaid provider and are a:
  • 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, 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 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).

A distant site provider should provide patients who receive a telemedicine service with guidance on the appropriate follow-up care.

Distant site providers must be licensed in Texas.

SOURCE: TX Medicaid Telecommunication Services Handbook, p. 8 (Sept. 2022) (Accessed Sept. 2022).

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.

SOURCE: TX Medicaid Telecommunication Services Handbook, p. 4 (Sept. 2022) (Accessed Sept. 2022).

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), postdoctoral 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.

SOURCE: TX Medicaid Telecommunication Services Handbook, p. 12 (Sept. 2022) (Accessed Sept. 2022).

The executive commissioner by rule shall ensure that a rural health clinic as defined by 42 U.S.C. Section 1396d(l)(1) and a federally-qualified health center as defined by 42 U.S.C. Section 1396d(l)(2)(B) may be reimbursed for the originating site facility fee or the distant site practitioner fee or both, as appropriate, for a covered telemedicine medical service, teledentistry dental service, or telehealth service delivered by a health care provider to a Medicaid recipient. The commission is required to implement this subsection only if the legislature appropriates money specifically for that purpose. If the legislature does not appropriate money specifically for that purpose, the commission may, but is not required to, implement this subsection using other money available to the commission for that purpose.

SOURCE: TX Statute Sec. 531.0216, (Accessed Sept. 2022).

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

  • Physicians
  • Physician assistants
  • Advanced Practice Registered Nurses (APRNs)
  • Certified nurse midwives
  • HHSC reimburses eligible distant site professionals providing telehealth services as follows:
  • Licensed marriage and family therapist (LMFT)
  • Licensed clinical social worker (LCSW) (including Comprehensive Care Program social workers)
  • Licensed psychologist
  • Licensed psychological associate
  • School Health and Related Services (SHARS)
  • Durable medical equipment suppliers

SOURCE:  TX Admin Code. Title 1, Sec. 355.7001 (Accessed Sept. 2022).

School Health and Related Services (SHARS)

Telehealth services delivered to children in school-based settings are a benefit of Texas Medicaid.

Schools that participate in the SHARS program may be reimbursed for telehealth OT, ST, and Counseling services delivered to children in school-based settings.

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

OT, ST, and Counseling services provided by school districts through SHARS can be delivered during school hours.

Providers may be reimbursed for telehealth services delivered to children in school-based settings with the following criteria:

  • Reimbursement for providers is only available when the patient site is a school-based setting.
  • All medical necessity criteria and prior authorization requirements for in-person services apply when services are delivered to children in school-based settings.

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

See manual for procedure codes are reimbursed when rendered as telehealth services to children eligible through SHARS. The patient site must be a school-based setting in order for the distant site provider to be eligible for reimbursement of these services, and all services should be billed using a 95 modifier to denote remote delivery.

SOURCE: TX Medicaid School Health and Related Services (SHARS) Handbook, pgs. 23-24 (Sept. 2022). (Accessed Sept. 2022).

FQHCS

FQHCs providing distant-site telehealth services may be reimbursed as the following:

  • FQHCs may be reimbursed the distant-site provider fee for telehealth 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, 13 (Sept. 2022). (Accessed Sept. 2022).

The executive commissioner by rule shall ensure that a rural health clinic as defined by 42 U.S.C. Section 1396d(l)(1) and a federally-qualified health center as defined by 42 U.S.C. Section 1396d(l)(2)(B) may be reimbursed for the originating site facility fee or the distant site practitioner fee or both, as appropriate, for a covered telemedicine medical service, teledentistry dental service, or telehealth service delivered by a health care provider to a Medicaid recipient. The commission is required to implement this subsection only if the legislature appropriates money specifically for that purpose. If the legislature does not appropriate money specifically for that purpose, the commission may, but is not required to, implement this subsection using other money available to the commission for that purpose.

SOURCE: TX Statute Sec. 531.0216, (Accessed Sept. 2022).

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:  Texas Admin Code Title 1, Sec. 355.8261, (Accessed Sept. 2022).

The commission by rule shall require each health and human services agency that administers a part of the Medicaid program to provide Medicaid reimbursement for teledentistry dental services provided by a dentist licensed to practice dentistry in this state.

The commission shall require reimbursement for a teledentistry dental service at the same rate as the Medicaid program reimburses for the same in-person dental service. A request for reimbursement may not be denied solely because an in-person dental service between a dentist and a patient did not occur. The commission may not limit a dentist’s choice of platform for providing a teledentistry dental service by requiring that the dentist use a particular platform to receive reimbursement for the service.

SOURCE: TX Govt. Code Sec. 531.02172, (Accessed Sept. 2022)

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 Sept. 2022).

Rural Health Clinics

RHCs rendering patient-site telemedicine services 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 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. The documentation must include a signed letter from the client’s treating health-care provider at the RHC. The signed letter must describe 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 RHC is eligible for payment of both an encounter fee and a telemedicine 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.

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 Clinics and other Outpatient Facility Services Handbook, pg. 32-33, (Sept. 2022). (Accessed Sept. 2022).


ELIGIBLE SITES

Telemedicine/Telehealth eligible originating (patient) sites:

  • An established medical site
  • A state mental health facility
  • State supported living centers.

SOURCE: TX Admin. Code, Title 1, Sec. 354.1432(1)(C) (Accessed Sept. 2022).

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 medical services.

SOURCE: TX Medicaid Telecommunication Services Handbook, pg. 4, 10 (Sept. 2022), (Accessed Sept. 2022).

School-Based Setting

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 (Sept. 2022), (Accessed Sept. 2022).

FQHCs may be reimbursed the distant-site provider fee for telemedicine and telehealth 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, pg. 10 & 13. (Sept 2022), (Accessed Sept. 2022).

TX Medicaid is required to reimburse school districts or open enrollment charter schools for telehealth services delivered by a health professional even if the specialist is not the patient’s primary care provider if the school district or charter school is an authorized health care provider under Medicaid and the parent or guardian of the patient consents.

A health professional is defined as:

  • Licensed, registered certified, or otherwise authorized by Texas to practice as a social worker, occupational therapist or speech language pathologist
  • Licensed professional counselor
  • Licensed marriage and family therapist
  • Licensed specialist in school psychology.

SOURCE: TX Government Code Sec. 531.02171. (Accessed Sept. 2022).

Services may take place in a school-based setting if:

  • 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 is present with the patient during treatment.

SOURCE: TX Admin. Code, Title 1, Sec. 355.7001(f); & TX Admin. Code, Title 1, Sec. 354.1432(1)(G). (Accessed Sept. 2022).

School Health and Related Services (SHARS)

Schools that participate in the SHARS program may be reimbursed for telehealth OT, ST, and Counseling services delivered to children in school-based settings.

SOURCE: TX Medicaid School Health and Related Services (SHARS) Handbook, pg. 23 (Sept. 2022). (Accessed Sept. 2022).

Rural Health Clinics

RHCs rendering patient-site telemedicine services 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 the RHC AIR (All Inclusive Rate) PPS per visit encounter rate.

SOURCE: Tx Medicaid Clinics and other Outpatient Facility Services Handbook, pg. 32, (Sept. 2022). (Accessed Sept. 2022).


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.

SOURCE: TX Admin. Code, Title 1 Sec. 355.7001(d) & TX Medicaid Telecommunication Services Handbook, p. 10. (Sept. 2022). (Accessed Sept. 2022).

Patient Site

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.

SOURCE: TX Medicaid Telecommunication Services Handbook, pg. 11 (Sept. 2022), (Accessed Sept. 2022).

Rural Health Clinics

RHCs rendering patient-site telemedicine services 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 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. The documentation must include a signed letter from the client’s treating health-care provider at the RHC. The signed letter must describe 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 RHC is eligible for payment of both an encounter fee and a telemedicine 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.

Last updated 09/07/2022

Miscellaneous

The commission in coordination with the department and single source continuum contractors shall establish guidelines in the STAR Health program to improve the use of telehealth services to provide and enhance mental health and behavioral health care for children placed in the managing conservatorship of the state.

SOURCE: Human Resources Code Title 2, Section D, Chapter 42, 42.260. (Accessed Sept. 2022).

Children’s Health Insurance Program

Allows reimbursement for live video telemedicine and telehealth services to children with special health care needs.

SOURCE: TX Govt. Code Sec. 531.02162, (Accessed Sept. 2022).

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

SOURCE: TX Medicaid Telecommunication Services Handbook, p. 9 and 12 (Sept. 2022). (Accessed Sept. 2022).

Providers of telehealth or telemedicine must maintain the confidentiality of protected health information (PHI) as required by Federal Register 42, Code of Federal Regulations (CFR) Part 2, 45 CFR Parts 160 and 164, Chapters 111 and 159 of the Texas Occupations Code, and other applicable federal and state law.

See provider manual for other information security and documentation requirements.

SOURCE: TX Medicaid Telecommunication Services Handbook, p. 4-5. (Sept. 2022). (Accessed Sept. 2022).

Fees for telemedicine, telehealth and home telemonitoring services are adjusted within available funding.

SOURCE: TX Admin Code. 355.7001(g). (Accessed Sept. 2022).

A valid practitioner-patient relationship must exist between the distant site provider and the patient receiving telemedicine services. 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).

The valid practitioner-patient relationship can be established through a call coverage agreement established in accordance with Texas Medical Board (TMB) administrative rules in 22 TAC §177.20.

A distant site provider should provide patients who receive a telemedicine service with guidance on the appropriate follow-up care.

SOURCE: TX Medicaid Telecommunication Services Handbook, p. 8 (Sept. 2022). (Accessed Sept. 2022).

Prescriptions Generated from a Telemedicine Medical Service

A distant site provider may issue a valid prescription as part of a telemedicine service. An electronic prescription (e-script) may be used as permitted by applicable federal and state statues and rules.

The same standards that apply for the issuance of a prescription during an in-person setting apply to prescriptions issued by a distant site provider.. The prescribing physician must be licensed in Texas. If the prescription is for a controlled substance, the prescribing physician must have a current valid U.S. Drug Enforcement Administration (DEA) registration number.

SOURCE: TX Medicaid Telecommunication Services Handbook, p. 9-10 (Sept. 2022). (Accessed Sept. 2022).

Radiation Therapy Services

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 (Sept. 2022). (Accessed Sept. 2022).

All client health information generated or utilized during a telehealth or telemedicine service must be stored by the distant site provider in a client health record. If the distant site provider stores the patient health information in an electronic health record, the provider should use software that complies with Health Insurance Portability and Accountability Act (HIPAA) confidentiality and data encryption requirements, as well as with the United States Department of Health and Human Services (HHS) rules implementing HIPAA.

Medical records must be maintained for all telemedicine services.

Documentation for a service provided via telemedicine must be the same as for a comparable in-person service.

If a patient has a primary care provider who is not the distant site provider and the patient or their parent or legal guardian provides consent to a release of information, a distant site provider must provide the patient’s primary care provider with the following information:

  • A medical record or report with an explanation of the treatment provided by the distant site provider
  • The distant site provider’s evaluation, analysis, or diagnosis of the patient

Unless the telemedicine services are rendered to a child in a school-based setting, distant site providers of mental health services are not required to provide the patient’s primary care provider with a treatment summary. For telemedicine provided to a child in a school-based setting, a notification provided by the telemedicine physician to the child’s primary care provider must include a summary of the service, exam findings, prescribed or administered medications, and patient instructions.

SOURCE: TX Medicaid Telecommunication Services Handbook, p. 5 & 11-12. (Sept. 2022). (Accessed Sept. 2022).

Screening activities for crisis stabilization units, including triage and determining if the individual’s need is urgent can be conducted in person or through telehealth.

SOURCE: TX Admin Code, Title 26, Part 1, Ch. 306, Subchapter B, Sec. 306.45, (Accessed Sept. 2022).

A patient can be admitted on a voluntary admission only if a physician has conducted or consulted with a physician who has conducted, either in person or through telemedicine medical services, an admission examination within 72 hours before or 24 hours after admission.

SOURCE: TX Admin Code, Title 26, Part 1, Ch. 568, Subchapter B, Sec. 568.22, (Accessed Sept. 2022).

The commission shall establish policies and procedures to improve access to care under the Medicaid managed care program by encouraging the use of telehealth services, telemedicine medical services, home telemonitoring services, and other telecommunications or information technology under the program.

To the extent permitted by federal law, the executive commissioner by rule shall establish policies and procedures that allow a Medicaid managed care organization to conduct assessments and provide care coordination services using telecommunications or information technology.  See rule for details.

SOURCE: TX Statute Sec. 533.039, (Accessed Sept. 2022).

In the event of a state of disaster declared pursuant to Texas Government Code §418.014 for statewide disasters or limited areas subject to the declaration, the flexibilities listed under subsection (c) of this section will be available until the state of disaster is terminated. Telehealth and telemedicine have the same meaning as the terms telehealth services and telemedicine medical services defined in §111.001 of the Texas Occupations Code (relating to Definitions).

See rule for additional details.

SOURCE: TX Admin Code Title 26, Part 1, Ch. 306, Subchapter X, 306.1251. (Accessed Sept 2022).

Last updated 09/07/2022

Out of State Providers

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).

SOURCE: TX Medicaid Telecommunication Services Handbook, pg. 8 (Sept. 2022). (Accessed Sept. 2022).

Last updated 09/07/2022

Overview

Texas Medicaid reimburses for live video, and store-and-forward in some circumstances. Home telemonitoring is reimbursable for some conditions when a provider is approved to deliver those services.

The Commission is required to develop and implement a system that ensures behavioral health services may be provided using an audio-only platforms.

Last updated 09/07/2022

Remote Patient Monitoring

POLICY

Home telemonitoring service means “a health service that requires scheduled remote monitoring of data related to a patient’s health and transmission of the data to a licensed home and community support services agency or a hospital”.

SOURCE: TX Government Code, Sec. 531.001(4-a). (Accessed Sept. 2022).

Texas Medicaid will reimburse for home telemonitoring in the same manner as their other professional services provided by a home health agency.

SOURCE: TX Admin Code, Title 1, Sec. 355.7001(e). (Accessed Sept. 2022).

Home telemonitoring is a health service that requires scheduled remote monitoring of data related to a client’s health, and transmission of the data from the client’s home to a licensed home health agency or a hospital. The data transmission must comply with standards set by HIPAA.

Data parameters are established as ordered by a physician’s plan of care.

Data must be reviewed by a registered nurse (RN), NP, CNS, or PA, who is responsible for reporting data to the prescribing physician in the event of a measurement outside the established parameters.

The provision and maintenance of home telemonitoring equipment is the responsibility of the home health agency or the hospital. The one-time initial setup and installation of the equipment in the client’s home is a benefit when services are provided by a home health agency or an outpatient hospital. Monthly home monitoring services are a benefit when services are provided by a home health agency or an outpatient hospital.

Documentation supporting medical necessity for telemonitoring services must be maintained in the client’s medical record by the entity providing the service (home health agency or hospital) and is subject to retrospective review. All paid telemonitoring services not supported by documentation of medical necessity are subject to recoupment.

Home telemonitoring services may be approved for up to 180 days per prior authorization request. Requests for additional home telemonitoring services received after the current prior authorization period ends will be denied for dates of service provided before the date the request was received. See manual for prior authorization requirements.

SOURCE: TX Medicaid Telecommunication Services Handbook, pg. 14-16 (Sept. 2022). (Accessed Sept. 2022).


CONDITIONS

Home Telemonitoring is available only to patients who:

  • Are diagnosed with diabetes, hypertension; or
  • When it is determined by Texas Health and Human Services Commission to be cost effective and feasible (in Administrative Code only).

To be eligible for home telemonitoring services, clients who are diagnosed with diabetes or hypertension must exhibit two or more of the following risk factors:

  • Two or more hospitalizations in the previous 12-month period
  • Frequent or recurrent emergency department visits
  • A documented history of poor adherence to ordered medication regime
  • Documented history of falls in the previous 6-month period
  • Limited or absent informal support systems
  • Living alone or being home alone for extended periods of time
  • A documented history of care access challenges

SOURCE: TX Admin Code. Title 1, Sec. 354.1434, TX Admin Code. Title 4 Sec. 531.02164 & TX Medicaid Telecommunication Services Handbook, p. 14; 16 (Sept 2022). (Accessed Sept. 2022).

Home telemonitoring is a benefit for clients who have been diagnosed with either diabetes or hypertension or both. Telemonitoring services will not be approved for clients of any age who have diabetes or hypertension unless they have two or more of the risk factors mentioned above.

Home telemonitoring services is also a benefit for clients who are 20 years of age and younger, with one or more of the following conditions:

  • End-stage solid organ disease
  • Organ transplant recipient
  • Requiring mechanical ventilation

SOURCE:  TX Medicaid Telecommunication Services Handbook, p. 14; 16 (Sept. 2022). (Accessed Sept. 2022).

The following conditions are also included in telemonitoring if the commission determines that it is cost-effective and feasible:  pregnancy, diabetes, heart disease, cancer, chronic obstructive pulmonary disease, hypertension, congestive heart failure, mental illness, asthma, myocardial infarction or stroke.

Home telemonitoring services are also available to pediatric persons who:

  • Are diagnosed with end-stage solid organ disease;
  • Have received an organ transplant; or
  • Require mechanical ventilation.

If, after implementation, the commission determines that the program established under this section is not cost-effective, the commission may discontinue the program and stop providing reimbursement under Medicaid for home telemonitoring services.

The commission shall determine whether the provision of home telemonitoring services to persons who are eligible to receive benefits under both Medicaid and the Medicare program achieves cost savings for the Medicare program.

To comply with state and federal requirements to provide access to medically necessary services under the Medicaid managed care program, a Medicaid managed care organization may reimburse providers for home telemonitoring services provided to persons who have conditions and exhibit risk factors other than those expressly authorized by this section. In determining whether the managed care organization should provide reimbursement for services under this subsection, the organization shall consider whether reimbursement for the service is cost-effective and providing the service is clinically effective.

SOURCE: TX Government Code Sec. 531.02164, (Accessed Sept. 2022).


PROVIDER LIMITATIONS

Data must be reviewed by a registered nurse (RN), NP, CNS, or PA, who is responsible for reporting data to the prescribing physician in the event of a measurement outside the established parameters.

Scheduled periodic reporting of the client data to the physician is required at least once every 30 days, even when there have been no readings outside the parameters established in the physician’s orders. The RN, NP, CNS, or PA in a licensed home health agency or a hospital is responsible for reporting data to the prescribing physician. Telemonitoring providers must be available 24 hours a day, 7 days a week. Although transmissions are generally at scheduled times, they can occur any time of the day or any day of the week, according to the client’s plan of care.

Collection and interpretation of a client’s data for home telemonitoring services (procedure code 99091) is a benefit in the office or outpatient hospital setting when services are provided by a physician or other qualified health care professional. Procedure code 99091 is limited to once in a 30-day period.

The physician who orders home telemonitoring services has a responsibility to ensure the following:

  • The client has a choice of home telemonitoring providers.
  • The client has the right to discontinue home telemonitoring services at any time.

SOURCE:  TX Medicaid Telecommunication Services Handbook, p. 14 (Sept. 2022). (Accessed Sept. 2022).

Providers must:

  • Comply with all applicable federal, state and local laws and regulations;
  • Be enrolled and approved as home telemonitoring services providers;
  • Bill for the services covered under the Texas Medicaid Program in the manner and format prescribed by HHSC;
  • Share clinical information gathered while providing home telemonitoring services with the patient’s physician; and
  • Not duplicate disease management program services.

See specific documentation requirements for telemonitoring providers in manual.

SOURCE: TX Admin Code. Title 1, Sec. 354.1434(c). (Accessed Sept. 2022).


OTHER RESTRICTIONS

Home health agency and hospital providers who wish to provide telemonitoring services must notify the Texas Medicaid & Healthcare Partnership (TMHP) as follows:

  • Current providers must use the Provider Enrollment and Management System (PEMS) to indicate that they provide telemonitoring services.
  • Newly enrolling or re-enrolling home health agency or outpatient hospital providers must indicate whether they provide telemonitoring services during the enrollment process.

The provision and maintenance of home telemonitoring equipment is the responsibility of the home health agency or the hospital. The one-time initial setup and installation (procedure code S9110 with modifier U1) of the equipment in the client’s home is a benefit when services are provided by a home health agency or an outpatient hospital. Monthly home monitoring services (procedure code S9110 with the appropriate modifier) are a benefit when services are provided by a home health agency or an outpatient hospital. Hospital providers must submit revenue code 780 with procedure code S9110 and one of the appropriate modifiers listed in the table within this section.

Documentation supporting medical necessity for telemonitoring services must be maintained in the client’s medical record by the entity providing the service (home health agency or hospital) and is subject to retrospective review. All paid telemonitoring services not supported by documentation of medical necessity are subject to recoupment.

Requests for additional home telemonitoring services that are received after the current prior authorization expires will be denied for dates of service that occurred before the date the submitted request was received.

SOURCE: TX Medicaid Telecommunication Services Handbook, pg. 3 & 14-15 (Sept. 2022). (Accessed Sept. 2022).

Last updated 09/07/2022

Store and Forward

POLICY

Store and forward technology – A telecommunications platform that stores and transmits or grants access to a person’s clinical information for review by a health professional at a different physical location than the person that meets the privacy requirements of the Health Insurance Portability and Accountability Act.

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, pg. 6, 9 & 13, (Accessed Sept. 2022).

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
  • 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, pg. 9, & 13 (Sept. 2022). (Accessed Sept. 2022).

TX Administrative Code includes definitions of “Telemedicine Medical Service,” “Telehealth Services” and “Telemedicine” which encompasses store-and-forward, stating that it includes “clinical data transmission using computer imaging by way of still-image capture and store-and-forward.”

SOURCE: TX Admin. Code, Title 1 Sec. 354.1430 (Accessed Sept. 2022).

Reimbursement to eligible providers must be made in the same manner as in-person services.

SOURCE: TX Admin. Code, Title 1 Sec. 355.7001. (Accessed Sept. 2022).


ELIGIBLE SERVICES

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, pg. 6, (Accessed Sept. 2022).

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.

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. (Sept. 2022). (Accessed Sept. 2022).

To the extent permitted by federal law and to the extent it is cost-effective and clinically effective, as determined by the commission, the commission shall ensure that Medicaid recipients, child health plan program enrollees, and other individuals receiving benefits under a public benefits program administered by the commission or a health and human services agency, regardless of whether receiving benefits through a managed care delivery model or another delivery model, have the option to receive services as telemedicine medical services, telehealth services [includes store and forward], or otherwise using telecommunications or information technology, including the following services:

  • preventive health and wellness services;
  • case management services, including targeted case management services;
  • subject to Subsection (c), behavioral health services;
  •  occupational, physical, and speech therapy services;
  • nutritional counseling services; and
  • assessment services, including nursing assessments under the following Section 1915(c) waiver programs:
    • the community living assistance and support services (CLASS) waiver program;
    • the deaf-blind with multiple disabilities (DBMD) waiver program;
    • the home and community-based services (HCS) waiver program; and
    • the Texas home living (TxHmL) waiver program.

SOURCE:  TX Statute Sec. 531.02161, (Accessed Sept. 2022).


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

Last updated 09/07/2022

Cross State Licensing

A telemedicine license may be issued for out of state providers. To qualify for an out-of-state telemedicine license, a person must:

  • Be 21 years of age or older;
  • Be actively licensed to practice medicine in another state which is recognized by the board for purposes of licensure, and not the recipient of a previous disciplinary action by any other state or jurisdiction;
  • Not be the subject of a pending investigation by a state medical board or another state or federal agency;
  • Have passed the Texas Medical Jurisprudence Examination;
  • Complete a board-approved application for an out-of-state telemedicine license for the practice of medicine across state lines and submit the requisite initial fee; and
  • Not be denied based on failure to demonstrate the requisite qualifications.

Limits on Out-of-State Telemedicine License. An out-of-state telemedicine license to practice medicine across state lines shall be limited exclusively to the interpretation of diagnostic testing and reporting results to a physician fully licensed and located in Texas or for the follow-up of patients where the majority of patient care was rendered in another state, and the license holder shall practice medicine in a manner so as to comply with all other statutes and laws governing the practice of medicine in the state of Texas. Unless a person holds a current full license to practice medicine in this state pursuant to this chapter and the provisions of the Medical Practice Act, Chapter 155 (relating to License to Practice Medicine), a person holding an out-of-state telemedicine license shall not be authorized to physically practice medicine in the state of Texas.

SOURCE: TX Admin. Code, Title 22, Sec. 172.12 (Accessed Sept. 2022).

Physicians who treat and prescribe through communications technology are practicing medicine and must possess a full Texas medical license when treating residents of Texas. An out-of-state physician may provide episodic consultations without a Texas medical license, as provided in Texas Occupations Code, §151.056, §172.2(g)(4) of this title (relating to Construction and Definitions), and §172.12(f) of this title (relating to Out-of-State Telemedicine License).

SOURCE: TX Admin. Code, Title 22, Part 9, Sec. 174.8. (Accessed Sept. 2022).

Based on change in law in 2017, a Full medical license is required to practice Telemedicine in Texas. Therefore, the issuance of telemedicine licenses has been suspended. Until further notice, there are no changes to the existing Telemedicine licenses registration procedures. Options to transitioning Telemedicine licenses to a Full license are under review. Please continue to check the Board’s website for updates.

SOURCE: TX Medical Board. (Accessed Sept. 2022).

Mental Health Services

A health professional may provide a mental health service that is within the scope of the professional’s license, certification, or authorization through the use of telemedicine or telehealth to a patient located outside of the state, subject to any applicable regulation of the jurisdiction in which the patient is located.

SOURCE: TX Occupations Code 113.002 (Accessed Sept. 2022).

Dentistry

A health professional providing a health care service or procedure as a teledentistry dental service is subject to the licensing requirements that would apply to the provision of the same health care service or procedure in an in-person setting.

SOURCE: TX Occupations Code 111.075, (Accessed Sept. 2022).

A person located in another state practices dentistry in this state and is required to hold a license to practice dentistry in this state if the person through the use of any medium, including an electronic medium, performs an act that constitutes the practice of dentistry on a patient in this state.

SOURCE: TX Occupations Code 251.003 (Accessed Sept. 2022).

Hearing Instrument Fitters and Dispensers

An individual shall not provide telehealth services to a client in the State of Texas, unless the individual holds a license or permit issued by the department and qualifies as a provider as that term is defined in this subchapter, or is otherwise legally authorized to do so.

SOURCE: TX Admin. Code Title 16, Sec. 112.132, (Accessed Sept. 2022).

Speech-Language Pathology and Audiology

An individual shall not provide telehealth services to a client in the State of Texas, unless the individual is licensed by the department and qualifies as a provider as that term is defined in this subchapter, or is otherwise legally authorized to do so.

SOURCE: TX Admin. Code, Title 16 Sec. 111.212. (Accessed Sept. 2022).

Last updated 09/07/2022

Definitions

Telehealth service means a health service, other than a telemedicine medical service or a teledentistry dental service, delivered by a health professional licensed, certified, or otherwise entitled to practice in this state 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.

“Telemedicine medical service” means a health care service delivered by a physician licensed in this state, or a health professional acting under the delegation and supervision of a physician licensed in this state, and acting within the scope of the physician’s or health professional’s license to a patient at a different physical location than the physician or health professional using telecommunications or information technology.

“Teledentistry dental service” means a health care service delivered by a dentist, or a health professional acting under the delegation and supervision of a dentist, acting within the scope of the dentist’s or health professional’s license or certification to a patient at a different physical location than the dentist or health professional using telecommunications or information technology.

SOURCE: TX Occupations Code 111.001. (Accessed Sept. 2022).

Speech-Language Pathology and Audiology

Telehealth is the use of telecommunications and information technologies for the exchange of information from one site to another for the provision of speech-language pathology or audiology services to a client from a provider, including for assessments, interventions, or consultations regarding a speech-language pathology or audiology client. For a provider who is an audiologist or an audiology intern, telehealth includes the use of telecommunications technology for the fitting and dispensing of hearing instruments. Telehealth is also referred to as telepractice.

Telehealth services is the application of telecommunication technology to deliver speech-language pathology and/or audiology services at a distance for assessment, intervention, and/or consultation including the rendering of audiology and/or speech-language pathology services through telehealth to a client who is physically located at a site other than the site where the provider is located. For a provider who is an audiologist or an audiology intern, telehealth services includes the fitting and dispensing of hearing instruments through telehealth to a client who is physically located at a site other than the site where the provider is located. Telehealth services are also referred to as telepractice services.

SOURCE: TX Admin. Code, Title 16 Sec. 111.210. (Accessed Sept. 2022).

Occupational Therapy

Telehealth is “a mode of service delivery for the provision of occupational therapy services delivered by an occupational therapy practitioner to a client at a different physical location using telecommunications or information technology. Telehealth refers only to the practice of occupational therapy by occupational therapy practitioners who are licensed by this board with clients who are located in Texas at the time of the provision of occupational therapy services. Also may be known as other terms including but not limited to telepractice, telecare, telerehabilitation, and e-health services.”

SOURCE: TX Admin. Code, Title 40 Sec. 362.1(36). (Accessed Sept. 2022).

Physical Therapy

Telehealth is a mode for providing one-on-one physical therapy services to a patient/client and is not a means for supervision of physical therapy aides.

SOURCE:  TX Admin. Code, Title 22, Sec. 322.5. (Accessed Sept. 2022).

Veterinary Medical Examiners

“Telemedicine” means veterinary medicine offered or provided by a person to a patient at a different physical location than the person using telecommunications or information technology.

SOURCE:  TX Admin. Code, Title 22, Sec. 573.68. (Accessed Sept. 2022).

Hearing Instrument Fitters and Dispensers

Telehealth–The use of telecommunications and information technologies for the exchange of information from one site to another for the provision of services to a client from a provider, including for assessments, interventions, or consultations regarding a client or for the fitting and dispensing of hearing instruments. Telehealth is also referred to as telepractice.

Telehealth services–The assessment, intervention, and/or consultation including the fitting and dispensing of hearing instruments through telehealth to a client who is physically located at a site other than the site where the provider is located. Telehealth services is also referred to as telepractice services.

SOURCE: TX Admin. Code Title 16, Sec. 112.130, (Accessed Sept. 2022).

Teledentistry 

“Teledentistry dental service” is defined in Texas Occupations Code §111.001(2-a).

SOURCE: TX Administrative Code Title 22, Part 5, Ch. 108, Rule 108.16. (Accessed Sept. 2022).

Last updated 09/07/2022

Licensure Compacts

Texas adopted the Nurses Licensure Compact.

SOURCE: Current NLC States & Status. Nurse Licensure Compact. (Accessed Sept. 2022).

Texas adopted the Physical Therapy Compact.

SOURCE: Compact Map. Physical Therapy Compact. (Accessed Sept. 2022).

Member of the Psychology Interjurisdictional Compact of the Association of State and Provincial Psychology Boards.

SOURCE:  Psypact Compact . (Accessed Sept. 2022).

Member of Recognition of EMS Personnel Licensure Interstate Compact (REPLICA).

SOURCE:  Interstate Commission for EMS Personnel Practice. EMS Compact Member States & Commissioners. (Accessed Sept. 2022).

Member of the Interstate Medical Licensure Compact .

SOURCE: Interstate Medical Licensure Compact Map. (Accessed Sept. 2022). 

* See Compact websites for implementation and license issuing status and other related requirements.

Last updated 09/07/2022

Miscellaneous

An e-Health Advisory Committee was established under TX Government Code Section 531.012 and is comprised of no more than 24 members, including:

  • At least one expert on telemedicine
  • At least one expert on home telemonitoring services
  • At least one representative of consumers of health services provided through telemedicine.

This section expires, on December 31, 2023.

SOURCE: TX Admin. Code, Title 1, Sec. 351.823.  (Accessed Sept. 2022).

Direct observation of a patient by a health professional or direct care or services provided to a patient by a health professional includes the provision of that observation, care, or service using telehealth services.

The commission may adopt rules as necessary to:

  • Ensure that patients receiving telehealth services receive appropriate, quality care;
  • Prevent abuse and fraud in the use of telehealth services, including rules relating to the filing of claims and records required to be maintained in connection with telehealth services;
  • Implement the requirements of Chapter 111 or other laws of this state regarding the provision of telehealth services or the protection of patients receiving telehealth services;
  • Provide for the remote supervision of assistants and other authorized persons performing duties within their existing scope of practice using telecommunications or information technology; and
  • Provide for the remote supervision of experience for apprentices, interns, or other similar trainees using telecommunications or information technology.

Rules under this section may allow for the provision of:

  • Remote education or distance learning for public or private schools; and
  • Continuing education using telecommunications or information technology.

SOURCE: TX Occupations Code Title 2, Ch. 51, Subchapter J, Sec. 51.501, (Accessed Sept. 2022).

Licensed Dyslexia Practitioners and Licensed Dyslexia Therapists

A licensed dyslexia practitioner may practice only in, or provide telehealth services from a remote location only to, an educational setting, including a school, learning center, or clinic.

A licensed dyslexia therapist may practice in, or provide telehealth services from a remote location to, a school, learning center, clinic, or private practice setting.

A license holder may provide telehealth services only in a practice setting described by this section, regardless of the physical location of the license holder or the recipient of the telehealth services.

SOURCE: TX Occupations Code 403.151, (Accessed Sept. 2022).

Occupational Therapists

The occupational therapist is responsible for determining whether any aspect of the evaluation may be conducted via telehealth or must be conducted in person.

The occupational therapist must have contact with the client during the evaluation. The contact must be synchronous audio and synchronous visual contact that is in person, via telehealth, or via a combination of in-person contact and telehealth. Other telecommunications or information technology may be used to aid in the evaluation but may not be the primary means of contact or communication.

SOURCE: TX Admin. Code, Title 40 Sec. 372.1. (Accessed Sept. 2022).

Last updated 09/07/2022

Online Prescribing

A valid practitioner-patient relationship is present between a practitioner providing a telemedicine medical service or a teledentistry dental service and a patient receiving the  service as long as the practitioner complies with the same standard of care as would apply in an in-person setting, and complies with one of the following scenarios:

  • Has a preexisting practitioner-patient relationship with the patient established;
  • Communicates, regardless of the method of communication, with the patient pursuant to a call coverage agreement established in accordance with Texas Medical Board rules with a physician requesting coverage of medical care for the patient or State Board of Dental Examiners rules with dentist requesting coverage of dental care for the patient; or
  • Provides the telemedicine medical services or teledentistry dental services through the use of one of the following methods, as long as the practitioner complies with follow-up requirements and the method allows the practitioner to have access to the relevant clinical information that would be required to meet the standard of care.
  • Synchronous audiovisual interaction between the practitioner and the patient in another location
  • Asynchronous store-and-forward technology, including in conjunction with synchronous audio interaction, as long as practitioner uses relevant clinical information from clinically relevant photographic or video images, or the patient’s relevant clinical records, such as the relevant medical or dental history, laboratory and pathology results, and prescriptive histories; or
  • Another form of audiovisual telecommunication technology that allows the practitioner to comply with the appropriate standard of care

A practitioner who provides telemedicine medical services to a patient shall provide the patient with guidance on appropriate follow up care and with the patient’s consent, forward the report of the encounter to the patient’s primary care physician within 72 hours.

A practitioner-patient relationship is not present for purposes of prescribing an abortifacient or other drug or device to terminate a pregnancy.

The Texas Medical Board, Texas Board of Nursing, Texas Physician Assistant Board, and the Texas Pharmacy Board are required to adopt joint rules that establish the determination of a valid prescription, which must allow for the establishment of the practitioner-patient relationship through telemedicine if it meets the standards outlined above.

This section does not apply to mental health services.

The State Board of Dental Examiners and the Texas State Board of Pharmacy shall jointly adopt rules that establish the determination of a valid prescription in accordance with Section 111.005. Rules adopted under this subsection must allow for the establishment of a practitioner-patient relationship by a teledentistry dental service provided by a dentist to a patient in a manner that complies with Section 111.005(a)(3) and must be substantially similar to the rules adopted under Subsection (a) of this section. The State Board of Dental Examiners and the Texas State Board of Pharmacy shall jointly develop and publish on each respective board’s Internet website responses to frequently asked questions relating to the determination of a valid prescription issued in the course of the provision of teledentistry dental services.

The State Board of Dental Examiners by rule shall establish limits on the quantity of a controlled substance, including an opiate, that a dentist may prescribe to a patient as a teledentistry dental service. Except as provided by Subsection (c), the rules may not authorize a dentist to prescribe more than is necessary to supply a patient for:

  1. if the prescription is for an opiate, a two-day period; or
  2.  if the prescription is for a controlled substance other than an opiate, a five-day period.

SOURCE: TX Occupations Code 111.005-.009, (Accessed Sept. 2022).

Teledentistry 

A dentist, dental hygienist, or dental assistant who delivers teledentistry services to a patient located in Texas must hold an active Texas license or registration issued by the Board.

The validity of a prescription issued as a result of a teledentistry dental service is determined by the same standards that would apply to the issuance of the prescription in an in-person setting.

This rule does not limit the professional judgment, discretion or decision-making authority of a licensed practitioner. A licensed practitioner is expected to meet the standard of care and demonstrate professional practice standards and judgment, consistent with all applicable statutes and rules when issuing, dispensing, delivering, or administering a prescription medication as a result of a teledentistry dental service.

A dental health professional providing a dental health care service or procedure as a teledentistry dental service:

  • must establish a practitioner-patient relationship

A valid prescription must be:

  • Issued for a legitimate dental purpose by a practitioner as part of patient-practitioner relationship as set out in Texas Occupations Code §111.005; and
  • Meet all other applicable laws and rules before prescribing, dispensing, delivering or administering a dangerous drug or controlled substance.

Any prescription drug orders issued as the result of a teledentistry dental service, are subject to all regulations, limitations, and prohibitions set out in the federal and Texas Controlled Substances Act, Texas Dangerous Drug Act and any other applicable federal and state law.

When prescribing a controlled substance to a patient as a teledentistry dental service, a dentist must not prescribe more than is necessary to supply a patient for:

  • If the prescription is for an opiate, a two-day period; or
  •  If the prescription is for a controlled substance other than an opiate, a five-day period.

SOURCE: TX Administrative Code Title 22, Part 5, Ch. 108, Rule 108.16. (Accessed Sept. 2022).

Board of Medical Examiners & Board of Nursing

A valid prescription must be:

  • issued for a legitimate medical purpose by a practitioner as part of patient-practitioner relationship as set out in §111.005, Texas Occupations Code; and
  • meet all other applicable laws before prescribing, dispensing, delivering or administering a dangerous drug or controlled substance.

Any prescription drug orders issued as the result of a telemedicine medical service, are subject to all regulations, limitations, and prohibitions set out in the federal and Texas Controlled Substances Act, Texas Dangerous Drug Act and any other applicable federal and state law.

Treatment for Chronic Pain. For purposes of this rule, chronic pain has the same definition as used in §170.2(4) of this title (relating to Definitions). Telemedicine medical services used for the treatment of chronic pain with scheduled drugs by any means other than via audio and video two-way communication is prohibited, unless a patient:

  • Is an established chronic pain patient of the physician or health professional issuing the prescription;
  • Is receiving a prescription that is identical to a prescription issued at the previous visit; and
  • Has been seen by the prescribing physician or health professional defined under Section 111.001(1) of Texas Occupations Code, in the last 90 days either:
    • in-person; or
    • via telemedicine using audio and video two-way communication.

Treatment for Acute Pain. For purposes of this rule, acute pain has the same definition as used in §170.2(2) of this title. Telemedicine medical services may be used for the treatment of acute pain with scheduled drugs, unless otherwise prohibited under federal and state law.

SOURCE: TX Admin. Code, Title 22, Part 9, Ch. 174.5 & Title 22, Part 11, Ch. 217.24, (Accessed Sept. 2022).

APRNs Treating Chronic Pain

An APRN, when determining whether to utilize telemedicine medical services for the treatment of chronic pain with controlled substances, shall give due consideration to factors that include, at a minimum, the date of the patient’s last in-person visit, patient co-morbidities, and occupational related COVID risks. These are not the sole, exclusive, or exhaustive factors an APRN should consider under this rule.

If a patient is treated for chronic pain with scheduled drugs through the use of telemedicine medical services, the medical records must document the exception and the reason that a telemedicine visit was conducted instead of an in-person visit.

SOURCE: TX Admin Code, Title 22, Part 11, Ch. 217.24, (Accessed Sept. 2022).

Establishing a practitioner-patient relationship is not required for prescription of medication to treat for sexually transmitted disease for partners of the physician’s established patient, if the physician determines that the patient may have been infected; or drugs or vaccines for after close contact with an infectious disease (see list of applicable diseases in regulation).

SOURCE: TX Admin. Code, Title 22, Part 9, Ch. 190.8(1)(L). (Accessed Sept. 2022).

An outpatient chemical dependency treatment program provided by a treatment facility may provide services under the program to adult and adolescent clients, consistent with commission rule, using telecommunications or information technology.

SOURCE: TX Health and Safety Code Sec. 462.015, (Accessed Sept. 2022).

Physicians who treat and prescribe through communications technology are practicing medicine and must possess a full Texas medical license when treating residents of Texas. An out-of-state physician may provide episodic consultations without a Texas medical license, as provided in Texas Occupations Code, §151.056, §172.2(g)(4) of this title (relating to Construction and Definitions), and §172.12(f) of this title (relating to Out-of-State Telemedicine License).

SOURCE: TX Admin. Code, Title 22, Part 9, Sec. 174.8. (Accessed Sept. 2022).

Last updated 09/07/2022

Professional Board Standards

TX Medical Board

SOURCE: TX Admin. Code, Title 22, Part 9, Ch.174. (Accessed Sept. 2022).

TX Board of Speech Pathology and Audiology

SOURCE: TX Admin. Code, Title 16, Part 4, Ch. 11, Subchapter V, Sec. 111.210-212, (Accessed Sept. 2022).

TX Board of Occupational Therapy Examiners

SOURCE: TX Admin. Code, Title 40, Ch. 372.1. (Accessed Sept. 2022).

TX Board of Optometry

SOURCE: TX Admin. Code, Title 22, Sec. 279.16. (Accessed Sept. 2022).

TX Board of Physical Therapy

SOURCE:  TX Admin. Code, Title 22, Sec. 322.5. (Accessed Sept. 2022).

TX Board of Veterinary Medical Examiners

SOURCE:  TX Admin. Code, Title 22, Sec. 573.68. (Accessed Sept. 2022).

Behavioral Analysts Program

SOURCE: TX Admin Code, Title 16, Sec. 121.70. (Accessed Sept. 2022).

Dyslexia Therapy Program

SOURCE: TX Admin Code, Title 16, Sec. 121.71. (Accessed Sept. 2022).

Hearing Instrument Fitters and Dispensers

SOURCE: TX Admin. Code Title 16, Sec. 112.132, (Accessed Sept. 2022).

The State Board of Dental Examiners, in consultation with the commissioner of insurance, as appropriate, may adopt rules necessary to:

  • Ensure that patients using teledentistry dental services receive appropriate, quality care;
  • Prevent abuse and fraud in the use of teledentistry dental services, including rules relating to the filing of claims and records required to be maintained in connection with teledentistry dental services;
  • Ensure adequate supervision of health professionals who are not dentists and who provide teledentistry dental services under the delegation and supervision of a dentist; and
  • Authorize a dentist to simultaneously delegate to and supervise through a teledentistry dental service not more than five health professionals who are not dentists.

The Texas Medical Board, in consultation with the commissioner of insurance, as appropriate, may adopt rules necessary to:

  • Ensure that patients using telemedicine medical services receive appropriate, quality care;
  • Prevent abuse and fraud in the use of telemedicine medical services, including rules relating to the filing of claims and records required to be maintained in connection with telemedicine medical services;
  • Ensure adequate supervision of health professionals who are not physicians and who provide telemedicine medical services; and
  • Establish the maximum number of health professionals who are not physicians that a physician may supervise through a telemedicine medical service.

SOURCE: TX Occupations Code 111.004. (Accessed Sept. 2022).

State Board of Dental Examiners

SOURCE: TX Administrative Code Title 22, Part 5, Ch. 108, Rule 108.16. (Accessed Sept. 2022).

Last updated 09/07/2022

Definition of Visit

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.

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:  Texas Admin Code Title 1, Sec. 355.8261, (Accessed Sept. 2022).

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

    • After the first encounter, the client suffers illness or injury requiring additional diagnosis or treatment.
    • The FQHC client has a medical visit and an other health visit such as a qualified clinical psychologist, clinical social worker, other health professional for mental health services, a dentist, a dental hygienist, an optometrist, or a THSteps medical checkup.

All services provided that are incidental to the encounter, including developmental screening, must be included in the total charge for the encounter. They are not billable as a separate encounter.

SOURCE: Tx Medicaid Clinics and other Outpatient Facility Services Handbook, pg. 13, (Sept. 2022). (Accessed Sept. 2022).

Last updated 09/07/2022

Eligible Distant Site

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 (Sept. 2022). (Accessed Sept. 2022).

Telemedicine eligible distant site providers are enrolled as a Texas Medicaid provider and are a:

  • Federally Qualified Health Center (FQHC)

SOURCE: TX Medicaid Telecommunication Services Handbook, p. 8 (Sept. 2022) (Accessed Sept. 2022).

See: TX Medicaid Live Video Distant Site

Last updated 09/07/2022

Eligible Originating Site

FQHCs are eligible for a facility fee when they serve as the patient site, indicating that they are an eligible originating site for telemedicine/telehealth.

See: TX Medicaid Live Video Eligible Sites.

Last updated 09/07/2022

Facility Fee

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.

SOURCE:  TX Medicaid Telecommunication Services Handbook, p. 11 (Sept. 2022). (Accessed Sept. 2022).

See: TX Medicaid Live Video Facility/Transmission Fee

Last updated 09/07/2022

Home Eligible

A patient site is the place where the client is physically located. A client’s home may be the patient site for telemedicine medical services.  However, there is no explicit referenced to whether or not FQHCs can provide services to patients while they are outside the FHQC or at home.

SOURCE: TX Medicaid Telecommunication Services Handbook, pg. 10 (Sept. 2022), (Accessed Sept. 2022).

Last updated 09/07/2022

Modalities Allowed

Live Video

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 Sept. 2022).

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.

FQHCs providing distant-site telehealth services may be reimbursed for the following procedure codes (see manual for specific codes).

SOURCE:  TX Medicaid Telecommunication Services Handbook, p. 10 & 13, (Sept. 2022). (Accessed Sept. 2022).

See:  TX Medicaid Live Video.


Store and Forward

TX Administrative Code includes definitions of “Telemedicine Medical Service,” “Telehealth Services” and “Telemedicine” which encompasses store-and-forward, stating that it includes “clinical data transmission using computer imaging by way of still-image capture and store-and-forward.” While the definition of telemedicine includes store-and-forward and the Medicaid manual indicates FQHCs are eligible for reimbursement, there isn’t an explicit mention of FQHCs being reimbursed for store-and-forward specifically.

See:  TX Medicaid Store and Forward.


Remote Patient Monitoring

Home telemonitoring is a covered service in the Texas Medicaid Telecommunications Handbook. However, CCHP has not found an explicit reference in Medicaid manuals for FQHCs.

See: TX Medicaid Remote Patient Monitoring.


Audio-Only

TX Medicaid reimburses for audio-only modality in some circumstances, however CCHP has not found an explicit reference in Medicaid manuals for whether or not FQHCs can be reimbursed for the modality.

See:  TX Medicaid Email, Phone and Fax.

Last updated 09/07/2022

Patient-Provider Relationship

No reference found

Last updated 09/07/2022

PPS Rate

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.

FQHCs providing distant-site telehealth services may be reimbursed as the following:

  • FQHCs may be reimbursed the distant-site provider fee for telehealth 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, pg. 10 & 13. (Sept 2022), (Accessed Sept. 2022).

Last updated 09/07/2022

Same Day Encounters

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.

SOURCE:  Texas Admin Code Title 1, Sec. 355.8261, (Accessed Sept. 2022).