A new Texas law closes a coverage gap that allowed insurers to deny or reduce reimbursement for out-of-state telehealth—but only under specific conditions.
Most health services owners don't realize that until recently, Texas health insurers could legally reimburse an out-of-state telehealth visit at a lower rate—or deny it altogether—even when the patient was a Texas resident and the provider held a Texas license. HB1052 closes that gap, but the rule comes with conditions that matter for your business.
Effective September 1, 2025, health benefit plans delivered, issued for delivery, or renewed on or after that date must cover out-of-state telehealth visits at the same reimbursement rate and on the same terms as in-state telehealth. The mandate applies to health plans covering employees at small businesses, as well as larger group plans.
The catch: the rule only applies when three conditions are met:
In plain terms, if your practice is licensed in Texas and you have a physical office here, you can now bill out-of-state telehealth visits to Texas health plans at the same rate you'd charge for a visit conducted from your Texas location. Insurers can no longer create a separate, lower reimbursement tier for out-of-state appointments.
This rule applies to health benefit plans—the insurance products that cover employees at businesses and organizations. It does not apply to Medicaid, Medicare, or workers' compensation plans.
If your health service operates a Texas-licensed practice with a Texas office, and you offer telehealth to patients who happen to be out of state (traveling, relocated, or otherwise), this law protects your reimbursement rate. It eliminates a coverage gap that previously allowed plans to pay less for the same service simply because the patient wasn't in the same physical location.
For health services considering telehealth expansion, this removes one barrier to serving patients across state lines. You no longer have to worry that a plan will reimburse an out-of-state visit at a reduced rate if your practice meets the three conditions above.
If you bill multiple plans, you may want to review your credentialing and contracting agreements to ensure they reflect this requirement. Some plans may need reminding that the law applies to renewals and new deliveries on or after September 1, 2025.
One note: the law does not require plans to cover out-of-state telehealth if they don't cover in-state telehealth. It only mandates equal treatment when both are covered.
This provision is found in Section 2 of HB1052, which adds Subsection (e) to Section 1455.004 of the Texas Insurance Code.
For a detailed, business-specific guide to HB1052 and other recent Texas telehealth rules, contact your state health services association or local business counsel.