Subchapter A. COVID-19 Emergency Rules 28 TAC §167.1
Q: When does this emergency rule go into effect?
A: This emergency rule goes into effect immediately for services provided on or after April 13, 2020, and is effective for 120 days. The Commissioner of Workers’ Compensation may extend the emergency rule for 60 more days.
Q: Where can I find the list of revised codes?
A: The list of approved telemedicine and telehealth codes is available on the Division of Workers’ Compensation’s (DWC) telemedicine/telehealth web page. See the “covered list of telehealth and telemedicine services.”
Q: Where can I find the U.S. Health and Human Services (HHS) emergency rule?
A: You can find the changes to the Centers for Medicare & Medicaid Services (CMS) telehealth requirements on the Federal Register web page.
Q: HHS excluded physical therapists, occupational therapists, and speech-language pathologists as distant site providers in the rule. Does the DWC emergency rule allow for reimbursement in the Texas workers’ compensation system?
A: The DWC emergency rule allows health care providers who are licensed to perform physical medicine and rehabilitation services to bill and be reimbursed for these services conducted through telemedicine or telehealth. They must use CMS’s revised list of covered telehealth services. This includes physical therapists, occupational therapists, and speech-language therapists.
Q: What is an originating site facility fee? Why is it not reimbursable in the Texas workers’ compensation system?
A: The originating site is the location of the patient, and the distant site is the location of the eligible health care provider. According to CMS, authorized originating sites are generally limited to:
- physicians or practitioner offices;
- hospitals;
- critical access hospitals (CAH);
- rural health clinics;
- federally qualified health centers;
- hospital-based or CAH-based renal dialysis centers, including satellites;
- skilled nursing facilities; and
- community mental health centers.
DWC’s emergency telemedicine and telehealth rules do not require an injured employee to receive telemedicine or telehealth services at an authorized originating site. DWC also does not have a geographic restriction on telemedicine or telehealth services.
Since the expansion of telehealth services is intended to encourage social distancing practices between injured employees and health care providers, DWC’s emergency telemedicine and telehealth services rule does not authorize the reimbursement of an originating site facility fee.
Q: Who can provide telemedicine or telehealth services in the Texas workers’ compensation system?
A: Health care providers must be allowed by their licensing board and DWC rules to provide telemedicine or telehealth services in workers’ compensation. See DWC Telemedicine rule here.
Q: What is synchronous telemedicine and telehealth?
A: Synchronous telemedicine and telehealth means using real-time audio and visual interaction between the health care provider and the patient.
Q: What is asynchronous telemedicine and telehealth?
A: Asynchronous telemedicine and telehealth are generally “store-and-forward” technologies that collect images and data to be transmitted and interpreted later by the health care provider, and include methods that are not real-time
Q: Does DWC allow reimbursement for asynchronous telemedicine and telehealth?
A: No. CMS does not allow for reimbursement of asynchronous telemedicine or telehealth services. DWC’s emergency rule states that only synchronous telemedicine and telehealth services conducted by real-time audio and visual interaction between a health care provider and a patient in a separate location may be reimbursed.
Q: Can MMI/IR services be delivered via telehealth/telemedicine?
A: No. Codes 99455 and 99456 are not among the CMS covered list of telehealth/telemedicine services in Texas.