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    v1.0.31
    OpenPayerPolicy UpdatesReimbursement/Payment PolicyDell Children's Telehealth Coverage | OpenPayer
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    CurrentDell Children's Health PlanPolicy H.B.4

    Behavioral Health Services Delivered by Synchronous Audio Visual or Telephone Interim Guidance

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    Interim guidance for Texas Medicaid providers and managed care organizations on reimbursement for medically necessary behavioral health services delivered through synchronous audio-visual or telephone technology.

    Policy Summary
    PayerDell Children's Health Plan
    PolicyBehavioral Health Services Delivered by Synchronous Audio Visual or Telephone Interim Guidance
    Policy CodePolicy H.B.4
    Change TypeAdded guidance
    Effective DateFeb 1, 2022
    Next Review DateN/A
    Key ActionSubmit claims for authorized behavioral health services delivered through synchronous audio-visual or synchronous telephone audio-only technology.
    SourceLink
    POLICY UPDATE CHANGES

    HHSC authorizes reimbursement submission for specified behavioral health services delivered through synchronous audio-visual or audio-only telephone modalities.

    2Authorized telehealth delivery modalities
    13Audio-visual procedure codes

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    10
    Audio-only procedure codes
    3Audio-visual service categories
    2Audio-only service categories
    Person-centeredModality selection standard

    Telehealth Behavioral Health Reimbursement Criteria

    Telehealth Behavioral Health Reimbursement Criteria

    Effective February 1, 2022, Medicaid providers may submit claims for reimbursement when the following behavioral health services are delivered through an authorized synchronous telehealth modality. This interim guidance remains in effect until the policy is codified in the Texas Administrative Code and future Texas Medicaid Provider Procedures Manual updates are finalized.

    ALL of the following

    • ONE authorized modality and an eligible service

      • Synchronous audio-visual technology

        • The service is delivered by synchronous audio-visual technology.

        • The service is one of the following

          • Screening, Brief Intervention and Referral to Treatment (SBIRT) Services — procedure codes 99408, G2011, or H0049.
          • Substance Use Disorder Assessment and Counseling Services — procedure codes H0001, H0004, or H0005.
          • Health and Behavior Assessment and Intervention (HBAI) Services — procedure codes 96156, 96158, 96159, 96164, 96165, 96167, or 96168.

      • Synchronous telephone (audio-only) technology

        • The service is delivered by synchronous telephone (audio-only) technology.

        • The service is one of the following

          • Screening, Brief Intervention and Referral to Treatment (SBIRT) Services — procedure codes 99408, G2011, or H0049.
          • Health and Behavior Assessment and Intervention (HBAI) Services — procedure codes 96156, 96158, 96159, 96164, 96165, 96167, or 96168.
    • The selected service modality is clinically appropriate and safe under applicable standards of care.
    • The selected service modality is agreed to by the person receiving services or the legally authorized representative (LAR).
    • The mode of service delivery is accessible, person- and family-centered, and primarily driven by the person's choice rather than provider convenience.

      Providers must defer to the needs of the person receiving services.

    Authorized Procedure Codes

    Synchronous audio-visual SBIRT servicesmixedCovered
    99408Screening, Brief Intervention and Referral to Treatment (SBIRT) services
    G2011Screening, Brief Intervention and Referral to Treatment (SBIRT) services
    H0049Screening, Brief Intervention and Referral to Treatment (SBIRT) services
    Synchronous audio-visual substance use disorder assessment and counselingHCPCSCovered
    H0001Substance use disorder assessment and counseling services
    H0004Substance use disorder assessment and counseling services
    H0005Substance use disorder assessment and counseling services
    Synchronous audio-visual HBAI servicesCPTCovered
    96156Health and Behavior Assessment and Intervention services
    96158Health and Behavior Assessment and Intervention services
    96159Health and Behavior Assessment and Intervention services
    96164Health and Behavior Assessment and Intervention services
    96165Health and Behavior Assessment and Intervention services
    96167Health and Behavior Assessment and Intervention services
    96168Health and Behavior Assessment and Intervention services
    Synchronous telephone audio-only SBIRT servicesmixedCovered
    99408Screening, Brief Intervention and Referral to Treatment (SBIRT) services
    G2011Screening, Brief Intervention and Referral to Treatment (SBIRT) services
    H0049Screening, Brief Intervention and Referral to Treatment (SBIRT) services
    Synchronous telephone audio-only HBAI servicesCPTCovered
    96156Health and Behavior Assessment and Intervention services
    96158Health and Behavior Assessment and Intervention services
    96159Health and Behavior Assessment and Intervention services
    96164Health and Behavior Assessment and Intervention services
    96165Health and Behavior Assessment and Intervention services
    96167Health and Behavior Assessment and Intervention services
    96168Health and Behavior Assessment and Intervention services

    Provider Billing and Modality Requirements

    Billing Rule

    Submit claims for authorized telehealth behavioral health services

    Submit claims for the listed behavioral health services when delivered through synchronous audio-visual or synchronous telephone audio-only technology. Authorized services include the specified SBIRT, substance use disorder assessment and counseling, and HBAI procedure codes.

    • Synchronous audio-visual codes: 99408, G2011, H0049; H0001, H0004, H0005; 96156, 96158, 96159, 96164, 96165, 96167, 96168.
    • Synchronous telephone audio-only codes: 99408, G2011, H0049; 96156, 96158, 96159, 96164, 96165, 96167, 96168.
    Documentation Required

    Apply clinical and consent standards

    Before providing the service, ensure the selected modality is clinically appropriate and safe, and that it is agreed to by the person receiving services or the legally authorized representative (LAR).

    Telehealth Terms

    Synchronous audio-visual technology
    TermSynchronous audio-visual technology
    DefinitionDelivery of behavioral health services using real-time audio-visual technology.
    UseAn authorized modality for listed behavioral health services when clinically appropriate, safe, and agreed to by the person receiving services or the legally authorized representative.
    Synchronous telephone audio-only technology
    TermSynchronous telephone audio-only technology
    DefinitionDelivery of behavioral health services using real-time telephone audio without video.
    Use
    Policy Summary
    PayerDell Children's Health Plan
    PolicyBehavioral Health Services Delivered by Synchronous Audio Visual or Telephone Interim Guidance
    Policy CodePolicy H.B.4
    Change TypeAdded guidance
    Effective DateFeb 1, 2022
    Next Review DateN/A
    Key ActionSubmit claims for authorized behavioral health services delivered through synchronous audio-visual or synchronous telephone audio-only technology.
    SourceLink
    On This Page
    Telehealth Behavioral Health Reimbursement CriteriaAuthorized Procedure CodesProvider Billing and Modality RequirementsTelehealth Terms
    Documentation Required

    Use person-centered modality selection

    Select the mode of delivery according to the person's needs and accessibility. The service must be person- and family-centered and primarily driven by the person's choice, not provider convenience.

    Billing Rule

    Prefer synchronous audio-visual delivery

    Use synchronous audio-visual technology instead of telephone audio-only delivery whenever possible.

    An authorized modality for listed behavioral health services when clinically appropriate, safe, accessible, and agreed to by the person receiving services or the legally authorized representative.
    LAR
    AbbreviationLAR
    Full termLegally authorized representative
    DefinitionThe legally authorized representative of the person receiving services.
    RoleMay agree to the selected service modality on behalf of the person receiving services.