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Texas Telemedicine

Telemedicine and Telehealth Services Texas Reimbursement Policy

Policy Type: Revised

Applies To: In-network Texas providers rendering telemedicine or telehealth services to members of fully-insured commercial medical plans subject to Texas Insurance Code (TIC) Chapter 1455.

Policy Implementation: Date of service

Effective Date: January 1, 2018

Revision Date: See Policy Revision Date

Applicable Insurance Code Section(s): TIC Sections 1455.001 - 1455.006; Texas Occupational Code Section 111.004

Payment policies are intended to ensure that providers are paid based on the code that most accurately describes the procedure performed, and may use CPT/HCPCS, CMS or other coding methodologies. Coding methodology, industry-standard payment logic, regulatory requirements, benefits design and other factors are considered in developing payment policies.

Policy

This policy addresses Texas Health + Aetna Life Insurance Company and Texas Health + Aetna Health Inc.’s guidelines regarding payment for telehealth and telemedicine services in Texas.

Services provided through telemedicine are considered as if they were provided face-to-face if the relevant standard of care requirements are met. Services are considered eligible if they are otherwise eligible under the plan. There are no CPT codes specific to telemedicine services.

Providers must bill with Place of Service 02 (Telehealth services) and/or modifier GT (via an asynchronous telecommunications system) or 95 (via a synchronous interactive audio and video telecommunications system) with an eligible CPT/HCPCS code. When physicians or healthcare professionals report modifier GT, they certify that they rendered services to a patient via an interactive audio and visual telecommunications system. HCPCS also eligible for coverage: 0188T, G0406, G0425, G0459, G0508, Q3014, S9110 and T1014.

We are not required to cover telehealth by only synchronous audio or asynchronous telecommunication interaction, including:

  • An audio-only telephone consultation;
  • A text only email message; or
  • A fax.

Definitions/Glossary

Policy Revision Date

  • Effective 01/01/2018: Revised to reflect changes in Texas Occupations Code Section 111.004andTIC Chapter 1455.
  • Effective 06/15/2001: Texas Insurance Code Chapter 1455 prohibits policy from requiring face-to-face contact between a health care provider and patient for delivery of care.

What's New

Health benefits and health insurance plans are offered and/or underwritten by Texas Health + Aetna Health Plan Inc. and Texas Health + Aetna Health Insurance Company (Texas Health Aetna). Each insurer has sole financial responsibility for its own products. Texas Health Aetna are affiliates of Texas Health Resources and of Aetna Life Insurance Company and its affiliates (Aetna). Aetna provides certain management services to Texas Health Aetna.

Self-funded plans are administered by Texas Health + Aetna Health Insurance Company.

This material is for information only and is not an offer or invitation to contract. An application must be completed to obtain coverage. Health benefits and health insurance plans contain exclusions and limitations. Providers are independent contractors and not our agents. Provider participation may change without notice. We do not provide care or guarantee access to health services. Not all health services are covered. See plan documents for a complete description of benefits, exclusions, limitations and conditions of coverage. Plan features and availability are subject to change and may vary by location. If you are in a plan that requires the selection of a primary care physician and your primary care physician is part of an integrated delivery system or physician group, your primary care physician will generally refer you to specialists and hospitals that are part of the delivery system or physician group. Information is believed to be accurate as of the production date; however, it is subject to change.

Physicians on the medical staff practice independently and are not agents or employees of the hospital or Texas Health Resources.

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