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Texas School-Based Services Telehealth

Eligible Providers

Occupational therapist and speech therapist providers may be reimbursed for telehealth services delivered to children in school-based settings with the following criteria:

  • Reimbursement for occupational therapist and speech therapist providers is only available when the patient site is a school-based setting.
  • Children receiving telehealth services rendered by occupational therapist and speech therapist providers must be eligible for these services through Texas Health Steps-Comprehensive Care Program (CCP).
  • All medical necessity criteria and prior authorization requirements for in-person OT and ST services apply when services are delivered to children in school-based settings.
  • Services provided to a client on public school or open-enrollment charter school premises are only permitted when delivered before or after school hours.

All other prior authorization, reimbursement, and billing guidelines that are applicable to in-person services will also apply when OT and ST services are delivered as telehealth services.

Licensed clinical social workers (LCSW), licensed professional counselors (LPC), licensed marriage and family therapists (LMFT), and psychologist providers may be reimbursed for telehealth services in school-based settings.

Children receiving telehealth services rendered by LCSW, LPC, LMFT, and psychologist providers must be eligible for these services through Texas Health Steps-CCP or through SHARS.

SHARS Telehealth Services

Schools that participate in the SHARS program may be reimbursed for telehealth OT and ST services delivered to children in school-based settings with the following criteria:

  • Children who are eligible for OT and ST services through SHARS may receive additional therapy through Texas Health Steps-CCP if medical necessity criteria is met.
  • OT and ST services provided by school districts through SHARS can be delivered during school hours.

Prior Authorization Requirements

The following initial evaluation and re-evaluation procedure codes do not require prior authorization for telehealth services:

92521

92522

92523

92524

97165

97166

97167

The following evaluation and re-evaluation procedure codes require prior authorization for telehealth services:

92507

92508

97150

97168

97530

S9152

Prior authorization is not required for procedure codes 92507, 92508, or 97150 when services are provided through SHARS.

Reimbursement

Telehealth services should be billed using modifier 95. The following OT and ST procedure codes may be reimbursed when rendered as telehealth services to children eligible through Texas Health Steps-CCP:

92507

92508

92521

92522

92523

92524

97150

97165

97166

97167

97168

97530

S9152

The following OT and ST procedure codes may be reimbursed when rendered as telehealth services to children eligible for services through SHARS:

92507

92508

92521

92522

92523

92524

97150

97165

97166

97167

97530

Procedure codes 92507, 92508, 92521, 92522, 92523, 92524, 97150, and 97530 should be billed with the following modifiers:

Modifier

Description

GO

OT Services

GN

ST Services

AT

Acute OT or ST Services

Modifiers GO and GN are required on all claims except when billing evaluation and re-evaluation procedure codes. The AT modifier must be included on claims for acute therapy services.

Citation

Texas Medicaid Provider Handbook: Telecommunications Services Handbook

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