Update to HB4: Behavioral Health Services Delivered by Synchronous Audio-visual or Telephone (Audio-only) Interim Guidance
Date: 04/29/22
Effective May 1, 2022, the Texas Health and Human Services (HHS) has authorized providers to submit claims for reimbursement for additional behavioral health services delivered by the telemedicine or telehealth modalities specified in this article.
This notice serves as interim guidance through August 31, 2022, as HHS is working to update the Texas Medicaid Provider Procedures Manual (TMPPM). The TMPPM update will provide additional benefit requirements and restrictions. The draft benefit language will be posted for public comment before it is finalized and made effective on September 1, 2022.
Note: To indicate remote delivery, providers must continue to use modifier 95.
Audio-visual Behavioral Health Modalities
Effective for dates of service February 1, 2022, through August 31, 2022, HHS has authorized Medicaid providers to submit claims for reimbursement of the following services delivered by synchronous audio-visual technology:
Description of Services | Procedure Codes |
|---|---|
Substance Use Disorder – Assessment and Counseling Services | H0001, H0004, H0005 |
Audio-visual and Telephone (Audio-only) Behavioral Health Modalities
Effective for dates of service February 1, 2022, through August 31, 2022, HHS has authorized Medicaid providers to submit claims for reimbursement of the following services delivered by synchronous telephone (audio-only) or synchronous audio-visual technology:
Description of Services | Procedure Codes |
|---|---|
Screening, Brief Intervention, and Referral to Treatment (SBIRT) Services | 99408, G2011, H0049 |
Health and Behavior Assessment and Intervention (HBAI) Services | 96156, 96158, 96159, 96164, 96165, 96167, 96168 |
Effective for dates of service May 1, 2022, through August 31, 2022, HHS has authorized Medicaid providers to submit claims for reimbursement of the following services delivered by synchronous telephone (audio-only) or synchronous audio-visual technology:
Description of Services | Procedure Codes |
|---|---|
Psychiatric Diagnostic Evaluation | 90791, 90792 |
Psychotherapy | 90832, 90834, 90837, 90846, 90847, 90853 |
Peer Specialist Services | H0038 |
Mental Health Rehabilitation Services | H0034, H2011, H2014, H2017 |
Mental Health Targeted Case Management (MHTCM) Services | T1017 |
Psychiatric Evaluation & Management (E/M) Services and Pharmacological Management | 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215 |
Important: For pharmacological management, providers must use the appropriate E/M procedure code with modifier UD to designate when a visit is primarily focused on pharmacological management.
Note: Procedure codes 90832, 90834, and 90837 are currently allowable through the audio-visual modality in the TMPPM.
For all the behavioral health services listed above, per standards of care, the service modality must be clinically appropriate, safe, and agreed to by the person receiving services or by the recipient’s Legally Authorized Representative (LAR). Providers must defer to the needs of the person receiving services, allowing the mode of service delivery to be accessible, person- and family-centered, and primarily driven by the person’s choice and not provider convenience.
Whenever possible, HHS encourages face-to-face interaction, such as in-person visits or synchronous audio-visual technology, over telephone audio-only technology for telemedicine and telehealth services.
Providers can refer to the Texas Medicaid Provider Procedures Manual, Behavioral Health and Case Management Services Handbook and Children’s Services Handbook for additional information about the Texas Medicaid behavioral health benefits and the Telecommunication Services Handbook for more information about current telemedicine and telehealth benefits.
For more information, call the TMHP Contact Center at 800-925-9126.