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UPDATE: Claims for Telephone (Audio-Only) Medical Services Background

Date: 04/19/23

Please Note: This information has been updated, please review: HHSC to End Telephone (Audio-only) Medical Services COVID-19 Guidance and Issue Temporary Guidance for Certain Audio-Only Services

Effective with the end of the federal PHE on May 11, 2023, HHSC will end the temporary flexibility that has been allowed for telephone (audio-only) medical (physician-delivered) E/M services. Providers may bill codes 99201-99205 and 99211-99215 for dates of service of March 15, 2020, through May 11, 2023, to receive Medicaid reimbursement for telephone (audio-only) medical services.

Key Details

To help ensure continuity of care during the COVID-19 (coronavirus) response, HHSC is authorizing providers to bill codes 99201-99205 and 99211-99215 for telephone (audio-only) medical (physician delivered) evaluation and management services delivered on March 15, 2020, through May 11, 2023*. Providers should continue to use the 95 modifier to indicate that remote delivery has occurred.

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.

*Please note: Previously, the end date for this guidance was April 30, 2020, then extended to May 31, June 30, July 31, October 23, November 30, December 31, 2020, January 31, February 28, March 31, April 30, May 31, June 30, July 31, August 31, September 30 and October 31; January 31, April 30, May 31, June 30, August 31, September 30, October 31,2022, November 30, 2022, January 31 and April 30, 2023. This notice is extended until May 11, 2023.