Texas Telemedicine & Telehealth Reimbursement Overview

Provider Reimbursement Eligibility
Consent for Telemedicine Live Video Reimbursement Store & Forward Reimbursement Originating Site & Transmission Fees Eligible Practitioners
State Law

Consent is required before a telemedicine session. It should be obtained by the originating or distant site professional. If the patient is a child, a parent/guardian should give consent. See Texas Administrative Code Rule 354.1432

State parity law covers clinically relevant video images. See Texas-2017-SB1101

Asynchronous store and forward is accepted as part of the ‘practitioner-patient relationship for telemedicine’ if in compliance with Sec. 111. 007 of See Texas-2017-SB1101

“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.” See Texas-2017-SB1101

No Reference Found

Medicaid

Adult consent is required.  See Pg. 5 of TX Medicaid Manual

Texas Medicaid will reimburse for specific classifications of services.
See Pg. 7 of TX Medicaid Manual

Effective September 1, 2019, SB670 covers live video telemedicine services at an equal rate to in-person services.

Texas Medicaid states telemedicine and telehealth only include interactive video communication, but the asynchronous store and forward technology may be used within FFS Medicaid.
See Pg. 7 of TX Medicaid Manual

Effective September 1, 2019, SB670 cover asynchronous technology, which can include store-and-forward and remote patient monitoring.

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

Telemedicine and Telehealth Services Benefit Policy Language Updated, Effective October 1, 2018

To find out if your provider class is eligible for Medicaid reimbursement, reference the appropriate Medicaid manual for your specialty.
See Pg 5 of TX Medicaid Manual

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

See Telemedicine Reimbursement Guide – Medicare Section

See Telemedicine Reimbursement Guide – Medicare Section

See Telemedicine Reimbursement Guide – Medicare Section

See Telemedicine Reimbursement Guide – Medicare Section

Private Payors

Private payors are actively exploring telemedicine and telehealth, but each provider is different. If you are in network with a specific provider, call and request documentation of their policy related to telehealth.

Self Pay

There are no limitations for self pay patients/clients, and providing telehealth services is a great way to increase revenue with patients that are selfpay or value premium services.

Provider Reimbursement Eligibility
Consent for Telemedicine
State Law

Consent is required before a telemedicine session. It should be obtained by the originating or distant site professional. If the patient is a child, a parent/guardian should give consent. See Texas Administrative Code Rule 354.1432

Medicaid

Adult consent is required.  See Pg. 5 of TX Medicaid Manual

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Live Video Reimbursement
State Law

State parity law covers clinically relevant video images. See Texas-2017-SB1101

Medicaid

Texas Medicaid will reimburse for specific classifications of services.
See Pg. 7 of TX Medicaid Manual

Effective September 1, 2019, SB670 covers live video telemedicine services at an equal rate to in-person services.

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Store & Forward Reimbursement
State Law

Asynchronous store and forward is accepted as part of the ‘practitioner-patient relationship for telemedicine’ if in compliance with Sec. 111. 007 of See Texas-2017-SB1101

Medicaid

Texas Medicaid states telemedicine and telehealth only include interactive video communication, but the asynchronous store and forward technology may be used within FFS Medicaid.
See Pg. 7 of TX Medicaid Manual

Effective September 1, 2019, SB670 cover asynchronous technology, which can include store-and-forward and remote patient monitoring.

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Originating Site & Transmission Fees
State Law

“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.” See Texas-2017-SB1101

Medicaid

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

Telemedicine and Telehealth Services Benefit Policy Language Updated, Effective October 1, 2018

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Eligible Practitioners
State Law

No Reference Found

Medicaid

To find out if your provider class is eligible for Medicaid reimbursement, reference the appropriate Medicaid manual for your specialty.
See Pg 5 of TX Medicaid Manual

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Private Payors

Private payors are actively exploring telemedicine and telehealth, but each provider is different. If you are in network with a specific provider, call and request documentation of their policy related to telehealth.

Self Pay

There are no limitations for self pay patients/clients, and providing telehealth services is a great way to increase revenue with patients that are selfpay or value premium services.

Telemedicine CPT Codes

Unique CPT codes do not exist specifically for telemedicine or telehealth. Instead a modifier is applied to existing codes.

  • For interactive audio and video sessions, place a GT modifier in front of the CPT codes you typically use for in person services.
  • For services provided via an asynchronous telecommunication system, simply add a GQ modifier in front of the CPT codes you typically use for in person services.

Telehealth Parity

Yes, there is a parity law. It requires reimbursement at, but not over, what would be charged for an in-person appointment.

See TX Insurance Code, Title 8, Section 1455.004

Medicaid service and payment parity effective as of September 1, 2019, with the passing of SB670.

Definitions

Telehealth Parity

Telehealth services are equal to in person services and reimbursed at the same rate.

Asynchronous Communication

The exchange of messages, such as among the hosts on a network or devices in a computer, by reading and responding as schedules permit rather than according to some clock that is synchronized for both the sender and receiver or in real time. Email, chat and text messaging are primary examples of asynchronous communication.

Distant or Hub Site

The location or site where the practitioner or provider is located while utilizing telemedicine services to meet with patients.

Originating Site

The location of the patient at the time services are provided. An originating site can be the client's home or a public facility like a rural hospital or physician's office. Many payors will reimburse for an originating site fee if it meets specific requirements. Rural use cases provide an applicable example for an eligible originating site fee where the patient will go to a local medical facility like a primary care physician's office and meet with a specialist located in distant urban health facility.

Additional Telemedicine Resources

Telehealth and telemedicine are fast growing and changing segments. Both state licensure and state legislation are changing rapidly along with federal legislation and for this reason the information provided cannot be considered legal advice. We make every attempt to keep state specific information up to date, but encourage you to validate this information through the following sites:

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