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 Feb. 2021).
Must use the “95” modifier for telemedicine/telehealth services (except for services that already indicate remote delivery in the description). See manual for codes that can be billed with the “95” modifier.
SOURCE: TX Medicaid Telecommunication Services Handbook, p. 7 and 11 (Feb. 2021). (Accessed Feb. 2021).
The software system used by the distant site and originating site (when patient presenter is used) must allow secure authentication of the distant site provider and the client.
See provider manual for other information security and documentation requirements.
SOURCE: TX Medicaid Telecommunication Services Handbook, p. 4. (Feb. 2021). (Accessed Feb. 2021).
Fees for telemedicine, telehealth and home telemonitoring services are adjusted within available funding.
SOURCE: TX Admin Code. 355.7001(g). (Accessed Feb. 2021).
A valid practitioner-patient relationship must exist between the distant site provider and patient. The relationship exists if the distant site provider meets the same standard of care required for an in-person service. A relationship is established through: a prior in-person services; a prior telemedicine medical services that meets the delivery modality requirements in TX Occupations Code Sec. 111.005(a)(3); or through the current telemedicine medical service. The relationship can be established through a call coverage agreement established in accordance with the Texas Medical Board rules.
Distant site providers should provide patients with written notification of the physician’s privacy practices as well as guidance on appropriate follow-up care.
SOURCE: TX Medicaid Telecommunication Services Handbook, p. 6 (Feb. 2021). (Accessed Feb. 2021).
A distant site provider may issue a valid prescription as part of a telemedicine medical service. 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. 8 (Feb. 2021). (Accessed Feb. 2021).
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. 62 (Feb. 2021). (Accessed Feb. 2021).
All patient health information generated or utilized during a telehealth or telemedicine medical service must be stored by the distant site provider in a patient 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 HHS rules implementing HIPAA.
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 medical 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 medical services provided to a child in a school-based setting, a notification provided by the telemedicine medical services 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 & 8-9. (Feb. 2021). (Accessed Feb. 2021).