September 27, 2022

Reminder

The Texas Health and Human Services Commission (HHSC) informed Blue Cross and Blue Shield of Texas (BCBSTX) of Medicaid fee-for-service (FFS), effective September 1, 2022, for the use of telemedicine and telehealth, delivery of medically necessary services to allow more services to be delivered permanently after the public health emergency (PHE) in regards to House Bill (HB) 4 requirements. Overview of FFS telemedicine and telehealth changes below.

What’s New

Blue Cross and Blue Shield of Texas (BCBSTX) is responsible for continuing to provide access to teleservices through implementation of key provisions of Senate Bill (SB) 670 (86^th-R) including:

• We cannot deny reimbursement to network providers for a covered health care service or procedure solely because it was delivered remotely via telemedicine or telehealth.
  
• We cannot deny or reduce reimbursement for a covered health care service or procedure based upon the network provider’s choice of platform.

Overview of Fee-for-Services (FFS) Telemedicine and Telehealth Changes

• Major changes to the policies including the following:
• Described and defined telephone (audio-only) technology services
• Added language regarding when telephone (audio-only) technology services may be authorized for use
• Added language regarding the use of the 93 and FQ modifiers
• Reorganized information about specific telemedicine and telehealth services within the Texas Medicaid Provider Procedures Manual handbooks

Specific Requirements for Services Provided through Synchronous Telephone (Audio-Only) Technology

Synchronous telephone (audio-only) technology between the provider and the client in another location may be used to provide some telemedicine and telehealth services within the Medicaid fee-for-service (FFS) as outlined in the notices listed in the “Additional Information” section below. Providers must ensure both the covered service and the delivery method are authorized by the Texas Health and Human Services Commission (HHSC).

Telemedicine and telehealth services provided through synchronous telephone (audio-only) technology must be billed with the appropriate modifier (93 or FQ) unless the procedure code indicates audio-only delivery in the code description.

Specific Requirements for Behavioral Health Services

Behavioral health services provided through synchronous telephone (audio-only) technology require the provider to obtain informed consent from the client, client’s parent, or the client’s legally authorized representative (LAR) before rendering a behavioral health service through a synchronous telephone (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.

Telemedicine and telehealth behavioral health services provided through synchronous telephone (audio-only) technology must be billed with a modifier (FQ). Procedure codes that indicate audio-only delivery in the description do not need to be billed with a modifier.

Additional Guidelines for Telemedicine and Telehealth Services

The following delivery methods may be used to provide telemedicine and telehealth services within FFS Medicaid:

• Synchronous audio-visual technology between the distant-site provider and the client in another location
• Synchronous telephone (audio-only) technology between the distant-site provider and the client in another location
• Store-and-forward technology, in conjunction with synchronous telephone (audio-only) technology between the distant-site provider and the client in another location

Not all Medicaid-covered services are authorized by HHSC for telemedicine or telehealth delivery in FFS. Providers must ensure that HHSC both allows the Medicaid-covered service to be delivered through telemedicine or telehealth and authorizes the delivery method.

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

Conditions for Reimbursement

Telemedicine and telehealth services that may be reimbursed in FFS are those that meet the following conditions when delivered using any of the methods noted below:

• Are designated for reimbursement by HHSC
  
• Meet criteria, including clinical effectiveness, cost-effectiveness, and other criteria, as determined by HHSC
• Are provided by a Texas Medicaid enrolled provider
• Are both in compliance with Chapter 111 of the Texas Occupations Code and within standards established by the respective licensing or certifying board of the professional providing the service
• May not be denied solely because an in-person healthcare service between a provider and client did not occur
• May not be limited by requiring the provider to use a particular technology platform to receive reimbursement for the service
• Other conditions for reimbursement applicable to services provided may vary by service type. Providers may refer to the appropriate Texas Medicaid Provider Procedures Manual handbook for additional information.

Beginning September 1, 2022, procedure codes for benefits that can be delivered through telemedicine or telehealth in FFS Medicaid will be outlined in the respective Texas Medicaid Provider Procedures Manual handbooks.

Note: During a Declaration of State of Disaster, HHSC may issue direction to providers regarding the use of telemedicine or telehealth services, including the use of a synchronous telephone (audio-only) platform to provide covered services outside of the allowances described in this article. 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.

Additional Guidelines for Telemedicine Services

All physicians must comply with 22 Texas Administrative Code §174.5 when issuing prescriptions through telemedicine.

Additional Information:

Details of these changes are found in the following provider notices that were published and are available on the TMHP website:

• Changes to Case Management for Children and Pregnant Women, Including Teleservices, Effective September 1, 2022, posted on July 18, 2022
• Telemedicine and Telehealth Benefit Information to Be Updated September 1, 2022, posted on July 15, 2022
• Behavioral Health Services Delivered by Telemedicine or Telehealth Effective September 1, 2022, posted on July 15, 2022
• Telemedicine and Telehealth Services for the HTW and HTW Plus Programs posted on July 15, 2022
• Telehealth Services for the Early Childhood Intervention Program posted on July 15, 2022
•  HB4 PT, OT, ST, and Related Durable Medical Equipment Services: Telehealth and Exclusions posted on July 15, 2022
• Synchronous Audio-visual Telemedicine Delivery for Certain Physician Evaluation and Management Procedure Codes Effective September 1, 2022, posted on July 15, 2022
• Medical Nutrition Counseling Policy Updated to Allow Procedure Code S9470 Through Synchronous Telephone (Audio-Only) Technologies Delivery posted on July 15, 2022
• Texas Health Steps Preventive Care Medical Check-ups Through Synchronous audio-visual or Synchronous Telephone (Audio-only) to Be Allowed During a State of Disaster posted on July 15, 2022

For more information, call the TMHP Contact Center at 1-800-925-9126.

Questions

For questions or additional information, please:

• Contact your BCBSTX Medicaid Network team at 1-855-212-1615 or
• Submit via email Texas Medicaid Network Department