TMPPM Language Update for Certain Telemedicine or Telehealth Services

Date: December 16, 2024

Attention: Providers

Effective date: December 1, 2024

Call to action: The purpose of this communication is to inform providers of language updates related to telemedicine and telehealth services for certain medical nutrition therapy services, medical nutrition counseling services, including those related to Health Texas Women Program, and end-stage renal disease conditions that appear in the Texas Medicaid Provider Procedures Manual (TMPPM) effective December 1, 2024. 

Link to Healthy Texas Women Program Site: https://www.healthytexaswomen.org/

Background: Health and Human Services Commission (HHSC) allowed the use of telemedicine and telehealth, to include the use of synchronous telephone (audio-only) technology, to deliver many Medicaid services during the COVID-19 public health emergency (PHE). House Bill 4, 87th Legislature, Regular Session, 2021, required HHSC to allow more services to be delivered using telemedicine or telehealth on a permanent basis after the PHE ends if clinically appropriate and cost-effective.

How this impacts providers: 

Telemedicine and telehealth services that may continue to be provided by synchronous audiovisual technology for medical nutrition therapy, medical nutrition counseling, and the diagnosis, evaluation, and treatment of end-stage kidney dialysis conditions, if clinically appropriate and safe, as determined by the provider and agreed to by the client receiving services:

• Medical nutrition therapy services (procedure codes 97802, 97803, and 97804).
• Medical nutritional counseling service (procedure code S9470).
• End-stage renal disease services (procedure codes, 90951, 90952, 90954, 90955, 90957, 90958, 90960, and 90961).

Services delivered by synchronous audiovisual technology must be billed using modifier 95.

New language will indicate that during certain public health emergencies or natural disasters, and if clinically appropriate and safe, as determined by the provider and agreed to by the client receiving services, the following procedure codes may be provided by synchronous telephone (audio-only) technology:

• Medical nutrition therapy services (procedure codes 97802, 97803, and 97804).
• Medical nutritional counseling service (procedure code S9470).
• Services delivered by synchronous telephone (audio-only) technology must be billed using modifier 93.

Next step for Providers: Providers should share this communication with their staff. 

If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org

For access to all provider alerts: https://www.texaschildrenshealthplan.org/provideralerts