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Telemedicine and Telehealth Services Texas Reimbursement Policy

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Defines payment and billing requirements for telemedicine and telehealth services provided by in‑network Texas providers to members of fully insured commercial medical plans subject to Texas Insurance Code Chapter 1455.

Policy Summary

Payerbannerhealthandaetnahealthinsurancecompany

PolicyTelemedicine and Telehealth Services Texas Reimbursement Policy

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateJan 1, 2018

Next Review DateN/A

Key ActionProviders must bill with Place of Service 02 and/or modifier GT or 95 when submitting eligible CPT/HCPCS codes for telehealth services.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

01/01/2018effective date for policy implementation

POS 02; GT/95billing elements required

8 codesexample HCPCS/CPT entries

Texas TIC Ch.1455statutory applicability

Coverage Criteria for Telemedicine/Telehealth

Coverage criteria for telemedicine/telehealth services

Covered when ALL of the following are met:

Services provided via telemedicine/telehealth are considered equivalent to face-to-face care when relevant standard of care requirements are met and the service is otherwise eligible under the member's plan.

Applies to in-network Texas providers rendering telemedicine or telehealth services to members of fully insured commercial medical plans subject to Texas Insurance Code Chapter 1455.

Providers must submit the appropriate eligible CPT/HCPCS code with Place of Service 02 (Telehealth) and/or modifier GT (asynchronous telecommunications) or modifier 95 (synchronous interactive audio and video telecommunications).

Telehealth coverage does not require payment for interactions that are only synchronous audio, asynchronous text-only, or fax; specifically excluded formats include audio-only telephone consultations, text-only email messages, and faxes.

Codes and Telehealth Modifiers

HCPCS/CPT examples eligible for telehealth coveragemixedCovered

0188T	HCPCS example code eligible for coverage
G0406	HCPCS example code eligible for coverage
G0425	HCPCS example code eligible for coverage
G0459	HCPCS example code eligible for coverage
G0508	HCPCS example code eligible for coverage
Q3014	HCPCS example code eligible for coverage
S9110	HCPCS example code eligible for coverage
T1014	HCPCS example code eligible for coverage

Telehealth modality and billing requirements

Required modality for telehealth billingSynchronous interactive audio-video required for modifier 95 or asynchronous telecommunications with modifier GT when submitting eligible CPT/HCPCS codes; providers must bill Place of Service 02.

Audio-only/text/fax coverageAudio-only telephone consultations, text-only email messages, and fax transmissions are not required to be covered by this policy.

Place of Service requirementProviders must bill with Place of Service 02 when submitting telehealth services.

Modifier meaningsModifier GT indicates asynchronous telecommunications system; modifier 95 indicates synchronous interactive audio and video telecommunications system.

Billing and Submission Requirements

Billing Rule

Bill telehealth with POS 02 and modifier GT or 95

Providers must bill telehealth claims using Place of Service 02 and/or the appropriate telehealth modifier: GT for services delivered via an asynchronous telecommunications system or 95 for services delivered via a synchronous interactive audio and video telecommunications system. Submit the eligible CPT/HCPCS code with POS 02 and/or modifier GT or 95 on the claim to meet billing requirements for telehealth services.

Place of Service 02 (Telehealth services) is required when submitting eligible CPT/HCPCS codes.
Use modifier GT to indicate services delivered via an asynchronous telecommunications system.
Use modifier 95 to indicate services delivered via a synchronous interactive audio and video telecommunications system.

Definitions

Asynchronous Telecommunication

DefinitionNon-interactive telecommunication where medical information (e.g., diagnostic images or video) is stored and forwarded from one site to another for a physician or health care practitioner to view later; the patient is not present during review.

Typical useStore-and-forward of diagnostic images or video for later review by a clinician at a different site.

InteractivityConsidered non-interactive because the clinician reviews information without the patient being present.

Synchronous Interactive Audio and Video Telecommunication

DefinitionReal-time interactive audio and video communication between a patient and a distant physician or health care practitioner, enabling two-way sight and sound throughout the encounter.

Key featurePhysician actually sees the patient during the communication so two-way (sight and sound) communication can take place.

Use caseReal-time video teleconferencing for diagnosis, consultation, or treatment when clinician and patient are in different physical locations.

Telemedicine / Telehealth

DefinitionUse of interactive audio, video, or other electronic media to deliver health care, including diagnosis, consultation, treatment, transfer of medical data, and medical education; excludes services provided solely by telephone or facsimile.

ScopeIncludes electronic media used for clinical services delivered when clinician and patient are at different physical locations; may involve physician delegation and supervision as permitted under Texas law.

ExclusionTelemedicine does not include services provided by a telephone or facsimile machine.

Policy Summary

Payerbannerhealthandaetnahealthinsurancecompany

PolicyTelemedicine and Telehealth Services Texas Reimbursement Policy

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateJan 1, 2018

Next Review DateN/A

Key ActionProviders must bill with Place of Service 02 and/or modifier GT or 95 when submitting eligible CPT/HCPCS codes for telehealth services.

SourceLink

On This Page

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Telemedicine and Telehealth Services Texas Reimbursement Policy

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Sign up for all bannerhealthandaetnahealthinsurancecompany policy alerts

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Coverage Criteria for Telemedicine/Telehealth

Coverage criteria for telemedicine/telehealth services

Covered when ALL of the following are met:

Applies to in-network Texas providers rendering telemedicine or telehealth services to members of fully insured commercial medical plans subject to Texas Insurance Code Chapter 1455.

Codes and Telehealth Modifiers

HCPCS/CPT examples eligible for telehealth coveragemixedCovered

0188T	HCPCS example code eligible for coverage
G0406	HCPCS example code eligible for coverage
G0425	HCPCS example code eligible for coverage
G0459	HCPCS example code eligible for coverage
G0508	HCPCS example code eligible for coverage
Q3014	HCPCS example code eligible for coverage
S9110	HCPCS example code eligible for coverage
T1014	HCPCS example code eligible for coverage

Telehealth modality and billing requirements

Audio-only/text/fax coverageAudio-only telephone consultations, text-only email messages, and fax transmissions are not required to be covered by this policy.

Place of Service requirementProviders must bill with Place of Service 02 when submitting telehealth services.

Modifier meaningsModifier GT indicates asynchronous telecommunications system; modifier 95 indicates synchronous interactive audio and video telecommunications system.

Billing and Submission Requirements

Billing Rule

Bill telehealth with POS 02 and modifier GT or 95

Place of Service 02 (Telehealth services) is required when submitting eligible CPT/HCPCS codes.
Use modifier GT to indicate services delivered via an asynchronous telecommunications system.
Use modifier 95 to indicate services delivered via a synchronous interactive audio and video telecommunications system.

Definitions

Asynchronous Telecommunication

Typical useStore-and-forward of diagnostic images or video for later review by a clinician at a different site.

InteractivityConsidered non-interactive because the clinician reviews information without the patient being present.

Synchronous Interactive Audio and Video Telecommunication

DefinitionReal-time interactive audio and video communication between a patient and a distant physician or health care practitioner, enabling two-way sight and sound throughout the encounter.

Key featurePhysician actually sees the patient during the communication so two-way (sight and sound) communication can take place.

Use caseReal-time video teleconferencing for diagnosis, consultation, or treatment when clinician and patient are in different physical locations.

Telemedicine / Telehealth

ExclusionTelemedicine does not include services provided by a telephone or facsimile machine.