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,” TMA President David C. Fleeger said. “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 Consultations

Effective March 20, 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. 

These policies will be in effect through April 30, HHSC said. 

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


Insurers to Cover Visits  

Governor Abbott on Tuesday 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. The Texas Medical Board will issue guidance in the coming days, including administrative guidance for billing to ensure claims are processed smoothly, the governor’s office said. 

These actions build upon waivers the governor issued last week to allow physicians to establish a doctor-patient relationship over the telephone.

HIPAA Restrictions Suspended  

Effective immediately, 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. 

Under a new 1135 waiver effective March 6: 

  • Medicare can 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.
  • These visits are considered the same as in-person visits and are paid at the same rate as regular, in-person visits. CMS will allow payment for any telehealth-covered code, even if unrelated to COVID-19 diagnosis, screening, or treatment.
  • Physicians may reduce or waive cost-sharing for telehealth visits paid by federal health care programs.
  • HHS will not enforce the established-relationship requirement that a patient must have seen the physician within the last three years.
  • As described above, physicians may provide services using smart phones that have audio and video capabilities.
  • Audio-only visits are allowed via telephone, but are paid at a different rate according to the CMS Medicare Telemedicine Fact Sheet.

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.

Last Updated On

March 31, 2020

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Ellen Terry

Project Manager, Client Services

(512) 370-1391

Ellen Terry has been writing, editing, and managing communication projects at TMA since 2000. She hails from Victoria, Texas; has a journalism degree from Texas State University; and loves to read great fiction. Ellen and her husband have two grown sons and a couple of cats.

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