Telemedicine Payments Promised, Regulations Eased
By Ellen Terry


To help Texas physicians safely and effectively treat patients during the COVID-19 pandemic, several changes to telemedicine visits have taken effect, including payment for services and which platforms can be used. 

“Physicians have important new tools to care safely for our most vulnerable patients in this crisis thanks to the timely actions by the Trump administration, Gov. Greg Abbott, Texas Medical Board President Sherif Zaafran, MD, and Insurance Commissioner Kent Sullivan,” then-TMA President David C. Fleeger said when the changes were announced in March. “We are working closely with congressional leaders to expand telemedicine payment parity to all health plans so we can provide the high quality of care all Texas patients deserve.” 

Medicaid to Pay for Telemedicine Consultations

Effective March 20 through Oct. 23, Medicaid and Medicaid managed care organizations (MCOs) will pay for audio-only telephone consultations as authorized by TMB. 

The Texas Health and Human Services Commission (HHSC) said covered evaluation and management CPT codes are 99201-05 and 99211-15 and should be billed with the -95 modifier. Medicaid and Medicaid MCOs also will pay for certain behavioral services provided over the telephone. 

The policy also applies to services for women enrolled in the Healthy Texas Women’s program and the Family Planning Program. 

For children enrolled in Medicaid, Texas Medicaid and MCOs also will pay for Texas Health Steps telemedicine visits for new and established patients older than 24 months. For detailed guidance about the policy, please refer to HHSC’s FAQs.

Additionally, effective March 18, HHSC will pay federally qualified health centers as telemedicine and telehealth service distant site providers.  

Insurers to Cover Visits  

Governor Abbott waived certain regulations and directed the Texas Department of Insurance (TDI) to issue an emergency rule relating to telemedicine provided through state-regulated insurance plans. 

Contracted or preferred physicians and other health care professionals will be eligible for payment from TDI-regulated insurance plans for medical visits they conduct over the phone instead of in person at the same rate they would receive for in-person visits. 

These actions built upon waivers the governor issued March 14 to allow physicians to establish a doctor-patient relationship over the telephone.

HIPAA Restrictions Suspended   Effective March 18, the U.S. Health and Human Services (HHS) Office for Civil Rights will not penalize physicians for noncompliance with HIPAA when they serve patients in good faith through common, nonpublic-facing communications technologies, such as FaceTime or Skype. 

This applies to services provided via telehealth for any reason, regardless of whether the service is related to the diagnosis and treatment of health conditions related to COVID-19, the office said. 

HHS encourages physicians to notify patients of the potential security risks of using these services, but notification is not required. Physicians should not use public-facing communication services like Facebook Live, Twitch, and TikTok. Physicians should still document the visit as though it took place in person. 

Physicians may want to check with individual payers regarding their telemedicine requirements in light of the HHS announcement

Medicare Telehealth Expands  

The Centers for Medicare & Medicaid Services (CMS) has temporarily broadened telehealth access to Medicare patients. 

  • Effective March 1 and throughout the national public health emergency, Medicare will pay physicians for telehealth services at the same rate as in-office visits for all diagnoses, not just COVID-19-related services. This includes audio-only telehealth visits.
  • Physicians can now provide more services to Medicare patients via telehealth, including emergency department visits. See the complete list of covered telehealth services for this public health emergency. CMS will consider adding appropriate services as they are requested.
  • Medicare will pay for office visits furnished via telehealth in all areas of the country (not only rural areas) and in any setting, including in a patient’s home.
  • Physicians can provide telehealth services to new and established patients.
  • Physicians may reduce or waive Medicare cost-sharing for telehealth visits (virtual check-ins, e-visits, and remote monitoring services).

For details, see Medicare Telehealth Frequently Asked Questions and the Texas Medical Association’s latest telemedicine tools and information. The Texas Medical Board also has published an FAQ on using telemedicine during the COVID-19 disaster declaration.

You can also find the latest news, resources, and government guidance on the coronavirus outbreak by visiting TMA’s COVID-19 Resource Center regularly.

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Last Updated On

July 30, 2020

Originally Published On

March 18, 2020

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