Texas Medicaid Telehealth Reimbursement

 Medicaid Reimbursement / Posted 1 year ago by Telehealthist

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Texas Medicaid reimburses for live video and store-and-forward in some circumstances. Home telemonitoring is reimbursable for some conditions when a provider is approved to deliver those services.

“Telehealth service” means a health service, other than a telemedicine medical service, that is delivered by a licensed or certified health professional acting within the scope of the health professional’s license or certification who does not perform a telemedicine medical service and that requires the use of advanced telecommunications technology, other than telephone or facsimile technology.

Live Video
Synchronous audiovisual interaction is reimbursable under Texas Medicaid.

Eligible Services/Specialties
Click for a list of reimbursable services.

Eligible Providers
Click for a list of eligible distant site providers.

Eligible Sites
Click for a list of eligible originating sites.

Geographic Limits
No reference found.

Facility/Transmission Fee
Patient-site providers that are enrolled in Texas Medicaid may only be reimbursed for the facility fee using procedure code Q3014. Procedure code Q3014 is payable to NP, CNS, PA, physicians, and outpatient hospital providers. Charges for other services that are performed at the patient site may be submitted separately. Procedure code Q3014 is not a benefit if the patient site is the client’s home.

Asynchronous store and forward technology, including asynchronous store and forward technology in conjunction with synchronous audio interaction between the distant site provider and the patient in another location is reimbursable under Texas Medicaid.

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Eligible Services/Specialties
No reference found.

Geographic Limits
No reference found.

Transmission Fee
No reference found.

Remote Patient Monitoring
Texas Medicaid will reimburse for home telemonitoring in the same manner as their other professional services provided by a home health agency.

Click to see list of patient eligibility.

Provider Limitations
Providers must be enrolled and approved as home telemonitoring services providers.

Other Restrictions
Click to see a list of risk factor criteria. Patients that meet the condition criteria must exhibit two or more of certain risk factors. Click to view the risk factors.

No reimbursement for audio-only telephone consultation.
No reimbursement for text-only email message.
No reimbursement for facsimile transmission.

Written or verbal consent must be obtained to allow any other individual (besides the distant site provider, patient site presenter or representative) to be present during a telemedicine or telehealth visit.

Out of State Providers
An out-of-state physician who is a distant site provider may provide episodic telemedicine medical services without a Texas medical license as outlined in Texas Statute and Regulation.

Click for a list of miscellaneous requirements for Texas Medicaid.

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