February 8, 2023
Since April 1, 2020, in response to the COVID-19 public health emergency (PHE), the Texas Health and Human Services Commission (HHSC) allowed Children and Pregnant Women (CPW) services, including comprehensive visits, to be completed by telephone (audio-only telecommunications). This will remain in place until HHSC provides further direction to Blue Cross and Blue Shield of Texas (BCBSTX) Medicaid.
Reminder that effective September 1, 2022, CPW comprehensive visits and follow-up visits completed using the synchronous audio-visual technology is a benefit of Texas Medicaid.
Guidance of existing CPW COVID-19 flexibilities and the coding requirements that align with national correct coding practice are as follows:
- CPW services, including comprehensive visits, may be completed by telephone (audio-only communications).
- When submitting a new prior authorization (CM-01) for a comprehensive visit completed using the telephone (audio-only telecommunications) to BCBSTX Medicaid, you must include “a telephone comprehensive visit was completed due to COVID-19”, in the psychosocial section of the prior authorization request form.
- Modifier 93 – must be included on the claim form when the comprehensive visit or follow-up visit is completed using the telephone (audio-only) telecommunications.
July 18, 2022 – TMHP Bulletin: Changes to Case Management for Children and Pregnant Women, Including Teleservices
January 17, 2023 – TMHP Notice: Update on Case Management for Children and Pregnant Women (CPW) Policy Changes and COVID-19 Flexibilities
Providers, 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.