Texas Medicaid Will Pay for Well-Child Visits Via Telemedicine in May

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Physicians can temporarily use telemedicine for Texas Health Steps (THSteps) medical checkups of children older than 24 months, the Texas Health and Human Services Commission (HHSC) announced Friday.

The guidance, which applies to both new and established patients, is effective until May 31. It is applicable for both managed care and fee-for-service Medicaid.

“Because some of these requirements (like immunizations and physical exams) require an in-person visit, providers must follow up with their patients to ensure completion of any components within 6 months of the telemedicine visit,” HHSC said.

Telemedicine or telephone-only for newborns “through the 24-month checkup” will not be permitted, HHSC said.

In early late March, the Texas Medical Association and Texas Pediatric Society (TPS) sent a letter asking HHSC to approve such payments. 

“Facilitating the quick uptake and expansion of telemedicine care now will ensure we can address the clinical needs of our patients as the COVID-19 crisis continues to unfold,” the letter said. Moreover, such payments are essential to practice viability because well-child visits are the foundation of pediatric care, the organizations said.

Early next week, TMA and TPS plan to ask HHSC to extend the approval beyond the end of May.

Although using audio and video is preferred, physicians should use their clinical judgment to determine when to use audio-only checkups, HHSC said.

Payment will be identical to current rates for THSteps checkup codes, which should be used for the initial visit as currently required, HHSC said.

“Providers may also bill for ‘add-on’ codes (e.g. developmental screening, mental health screening, etc.) as they normally would,” HHSC said. “Modifier 95 must be included on the claim form to indicate remote delivery.”

Stay up to date with the latest news, resources, and government guidance on the coronavirus outbreak by visiting TMA’s COVID-19 Resource Center regularly.

Last Updated On

May 08, 2020

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