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    v1.0.31
    OpenPayerPolicy UpdatesReimbursement/Payment PolicyDell Children's RHC Telehealth Coverage | OpenPaye…
    Ask Trek AI about this page
    CurrentDell Children's Health PlanPolicy N/A

    Telemedicine and Telehealth Services Provided by Rural Health Clinics

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    Reimbursement and billing requirements for Texas Medicaid rural health clinic providers furnishing patient-site and distant-site telemedicine or telehealth services, including facility fees, encounter billing, multiple consultations, required modifiers, and applicable procedure codes.

    Policy Summary
    PayerDell Children's Health Plan
    PolicyTelemedicine and Telehealth Services Provided by Rural Health Clinics
    Policy CodePolicy N/A
    Change TypeNo material change
    Effective DateApril 1, 2022
    Next Review DateN/A
    Key ActionBill telemedicine and telehealth services with modifier 95 unless the procedure code description already indicates remote delivery.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    Q3014Patient-site facility fee
    T1015Distant-site RHC services
    95Telemedicine modifier
    RequiredSeparate claim requirement

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    RHC Telemedicine and Telehealth Reimbursement

    RHC Telemedicine and Telehealth Reimbursement

    For dates of service on or after April 1, 2022, RHC telemedicine and telehealth services are reimbursable when the applicable service, setting, medical-necessity, coding, and claim-submission requirements below are met.

    ALL applicable requirements

    • Patient-site telemedicine facility fee

      • The RHC performs patient-site telemedicine services.

        The patient-site facility fee is reimbursable to the RHC.

      • The service is rendered in an office or outpatient hospital setting.
      • The facility fee is billed with procedure code Q3014 as an add-on procedure code.

    • Distant-site telemedicine and telehealth service

      • The RHC provides a distant-site telemedicine or telehealth service that was allowed in response to the COVID-19 public health emergency.

        These services are a permanent Texas Medicaid benefit effective for dates of service on or after April 1, 2022.

      • The service is submitted with procedure code T1015.

    • Multiple distant-site consultations on the same date of service

      • More than one facility fee for the same client on the same date of service is billed only when multiple distant-site provider consultations are medically necessary.

        MCOs are encouraged to monitor multiple distant-site provider consultations for the same client on the same date of service to ensure medical necessity.

      • For Medicaid fee-for-service, the RHC has a signed letter from the client's treating health-care provider at the RHC documenting the medical need for the multiple consultations.

        The letter must state that the client suffered an illness or injury requiring additional diagnosis or treatment by a distant-site provider.

    • Claim submission and billing

      • When the RHC is eligible for both an encounter fee and a telemedicine facility fee for the same client on the same date of service, the facility-fee claim is submitted separately from the encounter-fee claim.
      • Telemedicine and telehealth services are billed with modifier 95.

        Procedure codes whose descriptions indicate remote delivery, including telemedicine medical services or telehealth services, do not need modifier 95.

    • For billing questions or additional information, contact Dell Children's Health Plan Provider Relations at 1-844-781-2343 or shpproviders@seton.org.

    Required Codes and Billing Rules

    Patient-site telemedicine facility feeHCPCSCovered
    Q3014Telemedicine facility fee; reimbursable as an add-on procedure code for eligible RHC patient-site telemedicine services
    Distant-site RHC telemedicine and telehealthHCPCSCovered
    T1015Procedure code required for eligible distant-site telemedicine and telehealth services provided by RHC providers
    Remote delivery billing modifierModifierCovered
    95Telemedicine modifier required unless the procedure code description already indicates remote delivery
    Multiple Same-Day Distant-Site Consultations
    Reimbursement conditionMore than one facility fee for the same client on the same date of service may be reimbursed for multiple distant-site provider consultations when medically necessary.
    Medical-necessity documentationFor Medicaid fee-for-service, the RHC must retain a signed letter from the client's treating health-care provider at the RHC documenting the medical need for multiple distant-site consultations.
    Required letter detailsThe letter must state that the client suffered an illness or injury requiring additional diagnosis or treatment by a distant-site provider.
    Monitoring expectationManaged care organizations are encouraged to maintain a process to monitor multiple distant-site provider consultations for the same client on the same date of service.

    Billing and Submission Requirements

    Billing Rule

    Bill the Patient-Site Facility Fee

    Bill the patient-site telemedicine facility fee as an add-on for eligible services provided by an RHC. Submit procedure code Q3014 when telemedicine services are rendered in the office or outpatient hospital setting, effective for dates of service on or after April 1, 2022.

    • Procedure code: Q3014
    • Effective date: April 1, 2022
    Billing Rule

    Bill Distant-Site RHC Services

    Bill eligible distant-site RHC telemedicine and telehealth services using procedure code T1015. This benefit is effective for dates of service on or after April 1, 2022.

    • Procedure code: T1015
    • Applies to eligible distant-site telemedicine and telehealth services provided by RHCs
    Policy Summary
    PayerDell Children's Health Plan
    PolicyTelemedicine and Telehealth Services Provided by Rural Health Clinics
    Policy CodePolicy N/A
    Change TypeNo material change
    Effective DateApril 1, 2022
    Next Review DateN/A
    Key ActionBill telemedicine and telehealth services with modifier 95 unless the procedure code description already indicates remote delivery.
    SourceLink
    On This Page
    RHC Telemedicine and Telehealth ReimbursementRequired Codes and Billing RulesBilling and Submission Requirements
    Documentation Required

    Document Medical Necessity for Multiple Consultations

    Support more than one facility fee for the same client on the same date of service with documentation of medical necessity for multiple distant-site provider consultations. The signed letter from the client's treating health-care provider at the RHC must state that the client suffered an illness or injury requiring additional diagnosis or treatment by a distant-site provider.

    • Obtain a signed letter from the client's treating health-care provider at the RHC.
    • Document the illness or injury and the need for additional diagnosis or treatment by a distant-site provider.
    Billing Rule

    Separate Encounter and Facility-Fee Claims

    If the RHC is eligible for payment of both an encounter fee and a telemedicine facility fee for the same client on the same date of service, submit the facility-fee claim separately from the encounter-fee claim.

    • Submit the telemedicine facility fee on a separate claim when both fees apply.
    Billing Rule

    Apply the Telemedicine Modifier

    Bill telemedicine and telehealth services with modifier 95 unless the procedure code description already indicates remote delivery. Procedure codes that identify telemedicine medical services or telehealth services do not require modifier 95.

    • Use modifier: 95
    • Do not add modifier 95 when the procedure code already indicates remote delivery