Texas Telemedicine & Telehealth Reimbursement Overview

Provider Reimbursement Eligibility
Consent for Telemedicine Live Video Reimbursement Store & Forward Reimbursement Originating Site & Transmission Fees Eligible Practitioners
State Law

Consent is required before a telemedicine session. It should be obtained by the originating or distant site professional. If the patient is a child, a parent/guardian should give consent. See Texas Administrative Code Rule 354.1432

Law requires reimbursement from private payers and Medicaid under certain restraints.
See Texas Administrative Codes:

531.0217

354.1432

531.02162

No reference found, however the Texas Government’s definition of telehealth/telemedicine includes Store & Forward.
See Texas Government code 531.001

No Reference Found

No Reference Found

Medicaid

No Reference Found

Texas Medicaid will reimburse for specific services.
See Texas Code 531.0216

Texas Medicaid states telemedicine and telehealth only includes interactive video communication.
See TX Medicaid Manual

Telemedicine patient site locations are reimbursed a facility fee. See TX Medicaid Manual

To find out if your provider class is eligible for medicaid reimbursement reference the appropriate  medicaid manual for your specialty.
Texas Medicaid Manual

Medicare

No Reference Found

Only applicable for rural areas at this time.  See Rural Telehealth Services Document

No Reference Found

Medicare will pay 80% of the lesser of the actual charge of $25.10 per live video session to the originating site(patient location).

List of Medicare Approved Practitioners (see page 2)

Private Payors

Private payors are actively exploring telemedicine and telehealth, but each provider is different. If you are in network with a specific provider, call and request documentation of their policy related to telehealth.

Self Pay

There are no limitations for self pay patients/clients, and providing telehealth services is a great way to increase revenue with patients that are selfpay or value premium services.

Provider Reimbursement Eligibility
Consent for Telemedicine
State Law

Consent is required before a telemedicine session. It should be obtained by the originating or distant site professional. If the patient is a child, a parent/guardian should give consent. See Texas Administrative Code Rule 354.1432

Medicaid

No Reference Found

Medicare

No Reference Found

Live Video Reimbursement
State Law

Law requires reimbursement from private payers and Medicaid under certain restraints.
See Texas Administrative Codes:

531.0217

354.1432

531.02162

Medicaid

Texas Medicaid will reimburse for specific services.
See Texas Code 531.0216

Medicare

Only applicable for rural areas at this time.  See Rural Telehealth Services Document

Store & Forward Reimbursement
State Law

No reference found, however the Texas Government’s definition of telehealth/telemedicine includes Store & Forward.
See Texas Government code 531.001

Medicaid

Texas Medicaid states telemedicine and telehealth only includes interactive video communication.
See TX Medicaid Manual

Medicare

No Reference Found

Originating Site & Transmission Fees
State Law

No Reference Found

Medicaid

Telemedicine patient site locations are reimbursed a facility fee. See TX Medicaid Manual

Medicare

Medicare will pay 80% of the lesser of the actual charge of $25.10 per live video session to the originating site(patient location).

Eligible Practitioners
State Law

No Reference Found

Medicaid

To find out if your provider class is eligible for medicaid reimbursement reference the appropriate  medicaid manual for your specialty.
Texas Medicaid Manual

Medicare

List of Medicare Approved Practitioners (see page 2)

Private Payors

Private payors are actively exploring telemedicine and telehealth, but each provider is different. If you are in network with a specific provider, call and request documentation of their policy related to telehealth.

Self Pay

There are no limitations for self pay patients/clients, and providing telehealth services is a great way to increase revenue with patients that are selfpay or value premium services.

Telemedicine CPT Codes

Unique CPT codes do not exist specifically for telemedicine or telehealth. Instead a modifier is applied to existing codes.

  • For interactive audio and video sessions, place a GT modifier in front of the CPT codes you typically use for in person services.
  • For services provided via an asynchronous telecommunication system, simply add a GQ modifier in front of the CPT codes you typically use for in person services.

Telehealth Parity

Yes there is a parity law. It requires reimbursement at but not over what would be charged for an in person appointment.

See TX Insurance Code, Title 8, Section 1455.004

 

Definitions

Telehealth Parity

Telehealth services are equal to in person services and reimbursed at the same rate.

Asynchronous Communication

The exchange of messages, such as among the hosts on a network or devices in a computer, by reading and responding as schedules permit rather than according to some clock that is synchronized for both the sender and receiver or in real time. Email, chat and text messaging are primary examples of asynchronous communication.

Distant or Hub Site

The location or site where the practitioner or provider is located while utilizing telemedicine services to meet with patients.

Originating Site

The location of the patient at the time services are provided. An originating site can be the client's home or a public facility like a rural hospital or physician's office. Many payors will reimburse for an originating site fee if it meets specific requirements. Rural use cases provide an applicable example for an eligible originating site fee where the patient will go to a local medical facility like a primary care physician's office and meet with a specialist located in distant urban health facility.

Additional Telemedicine Resources

Telehealth and telemedicine are fast growing and changing segments. Both state licensure and state legislation are changing rapidly along with federal legislation and for this reason the information provided cannot be considered legal advice. We make every attempt to keep state specific information up to date, but encourage you to validate this information through the following sites: