Texas Telemedicine Policy, Simplified.

Healthcare legislation is complicated. Let’s clarify a few things.

We strive to keep this information updated and current. It is intended to be an informative guide, and not a comprehensive legal resource. Always consult with your local team of experts and administrators.

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Texas Telemedicine Policy

updated October 2019

Texas Telemedicine Policy

Texas is an example of the tremendous potential telemedicine has to treat many more patients for far less cost.  Telemedicine has expanded rapidly in Texas due to the growing shortage of healthcare providers. The state also has a telehealth parity law, requiring coverage of these services by private insurance companies, state employee health plans, and Medicaid. Read on to find out more about telehealth policy in Texas!

State Policy Overview

Medicaid
Private Payers
Parity

Additional state telemedicine information

  • Parity Laws

    Texas enacted its telehealth parity law in 1997. A telemedicine parity law requires private payers to reimburse telemedicine services in the same way as in-person services.

  • Medicaid

    Texas Medicaid has two distinctly different definitions for “telemedicine” and “telehealth,” where telehealth refers to other health services that do not require clinical assessment, diagnosis and treatment. The program covers live video for office consultations, outpatient visits and psychiatric services, as well as home telemonitoring services for some chronic conditions.

  • Type of Telemedicine Covered

    Texas Medicaid defines the purpose of telemedicine and telehealth services as those that “require the use of advanced telecommunications technology, other than telephone or facsimile technology…” and includes two-way video, audio or data transmission, store-and-forward care, and “other technology that facilitates access to health care services or medical specialty expertise.” In some cases, remote patient monitoring solutions are also covered.

  • Covered Health Services

    Under Texas Medicaid, the following telemedicine services are covered:

    • Consultations
    • Office or other outpatient visits
    • Psychiatric diagnostic interviews
    • Pharmacologic management
    • Psychotherapy
    • Data transmission
    • Diabetes management
    • Hypertension management

    Medicaid places some limitations on this coverage. For example, coverage is not mandatory if the patient can reasonably access an in-person visit with a physician in their area. Patients also have to receive an in-person exam before the telehealth service, except for mental health conditions.

  • Eligible Healthcare Providers

    While Texas law does not specify eligible providers, Medicaid does. The following providers can practice telemedicine or telehealth as long as they are enrolled as a Texas Medicaid provider:

    • Physician
    • Certified Nutrition Specialist
    • Advanced Practice Registered Nurse (APRNs)
    • Nurse Practitioner
    • Physician Assistant
    • Certified Nurse Midwife
    • Licensed professional counselors
    • Licensed marriage and family therapist
    • Licensed clinical social worker
    • Psychologist
    • Licensed psychological associate
    • Provisionally licensed psychologist
    • Licensed dietician

  • Online Prescriptions

    Texas requires physicians to have an established relationship with the patient before prescribing medications via telehealth. However, recent legislation now allows that relationship to be established through a live video telemedicine visit.

  • Informed Patient Consent

    Texas law requires a signed and dated patient consent form before providing services via telemedicine. 

  • Cross-State Telemedicine Licensing

    Although Texas is not yet part of the Interstate Medical Licensure Compact, out-of-state providers can get a telemedicine license to practice in the state. 

  • Restrictions on Locations

    Under Texas Medicaid, patients receiving virtual care have to be at an eligible originating site. Here’s the list of sites that qualify:   

    • An established medical site
    • A Mental health facility
    • State supported living center
    • School-based setting

  • Reimbursement Rates

    Since Texas has a telehealth parity law, payers have to reimburse for telehealth in the same way as in-person services.

  • Billing Codes

    In most cases, when you’re billing a telemedicine service through Texas Medicaid, you’ll need to include the appropriate covered CPT code along with the “95” modifier for telemedicine services (except for services that already indicate remote delivery in the description).

    For a full list of billing codes that can use the 95 modifier, see your Texas Medicaid Telemedicine Provider Manual. 

  • Documenting Barriers to In-Person Care

    Before receiving virtual care, patients must have an in-person evaluation for the relevant diagnosis or condition at least once within the previous 12 months. The one exception to this rule is for patients with mental health conditions.

  • Helpful Resources

    We used the sites below to gather information for this guide. Check them out for more details on your state’s policy!

Additional resources to help you get started.

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