Update – Telemedicine & Telehealth Services and COVID-19

Attention: All ProvidersEffective Date: March 17, 2020Texas Children’s Health Plan supports the delivery of telemedicine and telehealth services to its members. As part of our COVID-19 Emergency Response, Texas Children’s Health Plan will add coverage of telemedicine services that are provided through only synchronous audio interactions (audio-only telephone consultation). How this impacts providers: Telemedicine services should be provided in compliance with standards established by the respective licensing or certifying board of the professional providing the services. While telemedicine services do not require authorization when provided by an in-network provider, telemonitoring services do require prior authorization. TCHP has relaxed the following Telemedicine guidelines during the COVID-19 event:

• Copays applicable to the CHIP program are to be waived for Telemedicine & Telehealth services due to the COVID-19 event.
• Telemedicine services provided via an “Audio Only” platform will be billable due to the COVID-19 event. Providers are to clearly document in the Member’s medical record the format of the interaction as “Audio Only” and all appropriate record content of the visit. TCHP will update providers as to how long this waiver will be in place in future communications.

Texas Children’s Health Plan follows the Medical Policy for Telemedicine and Telehealth Services as written in the current Texas Medicaid Provider Procedures Manual – Telecommunication Services Handbook. Please reference: http://www.tmhp.com/manuals_pdf/tmppm/tmppm_living_manual_current/2_Telecommunication_Srvs.pdf  for additional information. Providers should verify that correct billing processes are in place including proper coding. Next steps for providers: Procedure Codes allowable for telephone only with appropriate documentation are: Medical Services: 99201-99205 and 99211-99215

• Behavioral Health Services:
• Psychiatric Diagnostic Evaluation: 90791, 90792
• Psychotherapy: 90832, 90834, 90837, 90846, 90847, 90853
• Peer Specialist Services: H0038
• Screening, Brief Intervention, and Referral to Treatment (SBIRT): H0049, G2011, 99408
• Substance Use Disorder Services: H0001, H0004, H0005
• Mental Health Rehabilitation: H0034, H2011, H2012, H2014, H2017

For telemedicine services, modifier 95 must be billed with these CPT codes and place of service code (POS) 02 - telemedicine services Telephonic evaluation and management services are not to be billed if clinical decision-making dictates a need to see the patient for an in-person or telemedicine (video) office visit within 24 hours or at the next available appointment. In those circumstances, the telephone service shall be considered a part of the subsequent office visit. If the telephone call follows an office visit performed and reported within the past seven calendar days for the same diagnosis, then the telephone services are considered part of the previous office visit and are not separately billed. If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org. For access to all provider alerts, log into: www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.