Interim Guidance for Synchronous Audiovisual Physical, Occupational, Speech Therapy Services

February 25, 2022

What is New?

Per the Texas Health and Human Services Commission (HHSC), it is transitioning certain COVID-19 telehealth flexibilities to interim guidance due to House Bill (H.B.) 4 (87^th Legislature, Regular Session, 2019). This session prohibits Medicaid health plans from denying reimbursement of audio-visual telemedicine or telehealth services solely because the services were delivered remotely for physical therapy (PT), occupational therapy (OT), and speech therapy (ST) services.

When is this effective?

Effective February 1, 2022, HHSC authorizes providers to submit claims for reimbursement for the following physical, occupational, and speech therapy services delivered by synchronous audio-visual technology. This interim guidance is in effect until future Texas Medicaid Provider Procedures Manual (TMPPM) updates are finalized.

Synchronous Audio-Visual PT, OT, and ST Evaluation and Treatment

Evaluation, re-evaluation, and treatment for the following procedure codes may be reimbursed when delivered by telehealth as determined clinically appropriate by the rendering therapist and in compliance with each discipline’s rules:

Are there specific billing requirements?

Billing requirements include:

•  Place of Service 02 
• Appropriate modifier GP/GO/GN in the primary position
•  Modifier 95 following the primary modifier

Note: All claims are subject to a post claims review.

Are new authorizations required?

No, existing authorizations for services do not require an update.

PT, OT, and ST In-Person Evaluation and Treatment

Specialized evaluations required for the provision of new complex rehabilitation technology, such as power mobility and adaptive seating systems or augmentative communication devices, require the physical presence of the speech-language pathologist, the occupational therapist, or the physical therapist and should not be delivered by telehealth.

The following procedure codes will not be reimbursed by synchronous audio-visual or audio-only technology:

Additional Information

Note: For the PT, OT, and ST services listed above, per standards of care, telehealth must be clinically appropriate, safe, and agreed to by the client receiving services or the legally authorized representative (LAR). Telehealth requires consent from the client or the client’s parent, or LAR. Verbal consent is permissible and should be documented in the client’s medical record. Telehealth may require the participation of a parent or caregiver to assist with the treatment. Providers must be able to defer to the needs of the person receiving services, allowing the mode of service delivery (audio-visual or in-person) to be accessible, person and family-centered, and primarily driven by the person in service’s choice and not provider convenience. Texas Medicaid does not reimburse for PT, OT, or ST delivered via telephone (audio-only).

To see full details, please review the following TMHP Notice: Synchronous Audio-Visual PT, OT, and ST Evaluation and Treatment Telehealth Services and Procedure Codes

For more information, call the TMHP Contact Center at 1-800-925-9126.

Questions

For questions or additional information please:

• Contact your BCBSTX Medicaid Network team at 1-855-212-1615 or
•  Submit via email Texas Medicaid Network Department
  

The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. References to other third-party sources or organizations are not a representation, warranty or endorsement of such organization. Any questions regarding those organizations should be addressed to them directly. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.