Houston, TX (WorkersCompensation.com) – In April, the Texas Division of Workers’ Compensation adopted a new rule, 28 Texas Administrative Code §133.30, which sets guidelines for Telehealth and Telemedicine for healthcare providers. It was effective as of Sept. 1. The new rule allows providers to bill and be reimbursed for certain medical services via telecommunication means, regardless of the injured employee’s location at the time of service.
According to the rule, Texas providers are required to follow CMS Medicare guidelines when billing CPT codes for these services. CMS Medicare recognizes many of the usual Evaluation and Management procedure codes, as well as Screening and Counseling codes for Telehealth.
Additionally, the rule specifies the difference between “Telehealth” and “Telemedicine” using Occupations Code §111.001.
Definitions include –
“Telehealth service” references a health service, other than a telemedicine medical service, delivered by a health professional licensed, certified, or otherwise entitled to practice in this state and acting within the scope of the health professional’s license, certification, or entitlement to a patient at a different physical location than the health professional using telecommunications or information technology.
“Telemedicine medical service” references a health care service delivered by a physician licensed in this state, or a health professional acting under the delegation and supervision of a physician licensed in this state, and acting within the scope of the physician’s or health professional’s license to a patient at a different physical location than the physician or health professional using telecommunications or information technology.
In regards to reimbursement, Rule 28 TAC Sec. 134.203 sets the reimbursement rate for services billed. Section 134.203 outlines the use for conversion factors utilized in calculations.
Another important note of interest: The MMI/IR rating codes for Physical Therapy (PT) 99455 and 99456 cannot be billed. For more information on codes, click here. Additionally, normally-recognized CMS PT codes such as 97161, 97162, 97163, 97110, 97112, 97750 etc. are not billable, and those are not listed in the CMS List of accepted codes.