State Telemedicine Policy Information
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Texas Telemedicine Policy
Texas Telemedicine Policy
Texas is an example of the tremendous potential telemedicine has to treat many more patients for far less cost. Telemedicine has expanded rapidly in Texas due to the growing shortage of healthcare providers. The state also has a telehealth parity law, requiring coverage of these services by private insurance companies, state employee health plans, and Medicaid.
State Policy Overview
Additional State Telemedicine Info
Texas enacted its telehealth parity law in 1997. A telemedicine parity law requires private payers to reimburse telemedicine services in the same way as in-person services.
Texas Medicaid has two distinctly different definitions for “telemedicine” and “telehealth,” where telehealth refers to other health services that do not require clinical assessment, diagnosis and treatment. The program covers live video for office consultations, outpatient visits and psychiatric services, as well as home telemonitoring services for some chronic conditions.
Type Of Telemedicine Covered
Texas Medicaid states that only services that involve direct face-to-face interactive video communication between the client and the distant-site provider constitute a telemedicine or telehealth service. That means live video and, in some cases, remote patient monitoring solutions.
Covered Health Services
Under Texas Medicaid, the following telemedicine services are covered:
- Office or other outpatient visits
- Psychiatric diagnostic interviews
- Pharmacologic management
- Data transmission
- Diabetes management
- Hypertension management
Medicaid places some limitations on this coverage. For example, coverage is not mandatory if the patient can reasonably access an in-person visit with a physician in their area. Patients also have to receive an in-person exam before the telehealth service, except for mental health conditions.
Eligible Healthcare Providers
While Texas law does not specify eligible providers, Medicaid does. The following providers can practice telemedicine or telehealth as long as they are enrolled as a Texas Medicaid provider:
- Certified Nutrition Specialist
- Advanced Practice Registered Nurse (APRNs)
- Nurse Practitioner
- Physician Assistant
- Certified Nurse Midwife
- Licensed professional counselors
- Licensed marriage and family therapist
- Licensed clinical social worker
- Licensed psychological associate
- Provisionally licensed psychologist
- Licensed dietician
Texas requires physicians to have an established relationship with the patient before prescribing medications via telehealth. However, recent legislation now allows that relationship to be established through a live video telemedicine visit.
Informed Patient Consent
Texas law requires a signed and dated patient consent form before providing services via telemedicine.
Restrictions On Locations
Under Texas Medicaid, patients receiving virtual care have to be at an eligible originating site. Here’s the list of sites that qualify:
- An established medical site
- A Mental health facility
- State supported living center
- School-based setting
Since Texas has a telehealth parity law, payers have to reimburse for telehealth in the same way as in-person services.
Documenting Barriers to In-Person Care
Before receiving virtual care, patients must have an in-person evaluation for the relevant diagnosis or condition at least once within the previous 12 months. The one exception to this rule is for patients with mental health conditions.
In most cases, when you’re billing a telemedicine service through Texas Medicaid, you’ll need to include the appropriate covered CPT code along with the “95” modifier for telemedicine services (except for services that already indicate remote delivery in the description).
For a full list of billing codes that can use the 95 modifiers, see your Texas Medicaid Telemedicine Provider Manual.