What is the Scope of Telemedicine in Texas Comp?

In 2017, the Texas Legislature passed a comprehensive bill addressing telemedicine in Texas, specifically removing certain limitations on its use. The Division of Workers’ Compensation’s telemedicine rule, designed to support the legislative change, took effect September 1, 2018. The rule aims to help expand the use of telemedicine – sometimes called ‘telehealth’ – in the state’s workers’ compensation system.

The Division maintains a telemedicine page on its website. In addition, the Division has published an FAQ page specifically devoted to telemedicine issues and questions.

Telemedicine – typically defined as a doctor or health care professional using computer or electronic video systems to examine a patient at another location – is already allowed in Texas. However, telemedicine within the workers’ compensation system has been limited by Medicare based reimbursement restrictions relating to “underserved” areas, which are typically rural regions with insufficient access to health care providers, and must be provided in a doctor’s office, hospital, or certain clinics.

The new DWC rule eliminates the Medicare based reimbursement restrictions that limit the use of telemedicine in workers’ compensation to these underserved areas. This will allow the use of telemedicine everywhere in Texas. The rule also eliminates the Medicare based requirement that the telemedicine service be provided in a doctor’s office, hospital, or certain clinic. Instead, an injured employee can be anywhere at the time they receive telemedicine services.

As more providers consider the application of telemedicine in their practices, we are receiving questions regarding what kinds of services may be furnished via telemedicine. Note the following Q&A from the DWC FAQ page:

Q: Can any medical service be delivered via telehealth/telemedicine?
A: No. The Division adopts, by reference, the list of telehealth services published annually by Medicare.

You can find a list of covered telehealth services published by Medicare for CY 2018 and CY 2019 at this link.

DWC has adopted Medicare coding, billing and documentation policies by reference. Medicare policies that conflict with the Division’s adopted rules do not apply.