12/08/2023
Per Texas Medicaid, Federally Qualified Health Care (FQHC) and Rural health Clinic (RHC) for procedure code Q3014 is now a benefit when telehealth services are rendered in the office or outpatient hospital setting.
What’s New
Effective for dates of service on or after November 1, 2023, the facility fee should not be included in any:
- FQHCs cost reporting that is used to calculate a prospective payment system (PPS) or alternative prospective payment system (APPS) per visit encounter rate; or
- In cost reporting that is used to calculate the RHC All Inclusive Rate (AIR) PPS per visit encounter rate.
Claims Reprocessing
Blue Cross and Blue Shield of Texas will reprocess claims submitted with dates of service on or after November 1, 2023, for procedure code Q3014 as a telehealth service; BCBSTX does not require providers to submit an appeal unless they are denied for other reasons after the claims reprocessing is complete.
Resources
Additional information from Article 09/15/2023.
Questions
Providers, for questions or additional information, please:
- Contact your BCBSTX Medicaid Network team at 1-855-212-1615
- Submit via email Texas Medicaid Network Department
The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. References to other third-party sources or organizations are not a representation, warranty, or endorsement of such organization. Any questions regarding those organizations should be addressed to them directly. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations, and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.