HIPAA compliance Texas

42 CFR Part 2 vs. HIPAA: A Texas Behavioral Health Guide 

If your practice treats substance use disorders in Texas, you’re not just working under HIPAA. You’re managing two more layers most guides never mention together — federal 42 CFR Part 2, and Texas’s own privacy law, House Bill 300. Miss how the three interact, and a routine records request can turn into a compliance problem fast. Quick answer: HIPAA sets the national baseline and generally allows sharing for treatment, payment, and operations without separate authorization. Understanding 42 CFR Part 2 Texas requirements alongside HIPAA is essential. It is stricter and narrower — it applies to substance use disorder records from federally assisted programs and generally requires patient consent even for routine sharing. Texas HB 300 adds a third, state-level layer on top of both.   What HIPAA Covers HIPAA is the framework most providers already know — national standards allowing covered entities to use and disclose records for treatment, payment, and healthcare operations without separate authorization for each instance. Broad and flexible by design.   What 42 CFR Part 2 Covers Part 2 is different. It applies specifically to records from federally assisted programs providing SUD diagnosis, treatment, or referral — not every behavioral health practice falls under it, but plenty do without realizing it. Historically, it required specific written consent before disclosing SUD records, even for routine treatment or payment purposes, with only narrow exceptions like medical emergencies. It also carries a redisclosure prohibition: once someone receives Part 2-protected information, they generally can’t pass it along further without meeting Part 2’s own rules — a restriction HIPAA doesn’t impose the same way.   Key Differences at a Glance   HIPAA 42 CFR Part 2 Consent for treatment/payment Generally not required separately Traditionally required specific consent Redisclosure Allowed under HIPAA’s rules Restricted — recipient bound by Part 2 Consent revocation Must be in writing Can historically be verbal Scope All protected health information SUD records from federally assisted programs only That consent revocation difference trips up more practices than you’d expect — a patient can verbally revoke Part 2 consent in a way that wouldn’t be sufficient under HIPAA for other records.   Related Resource Strengthen HIPAA Compliance Across Your Revenue Cycle Protect patient information, reduce compliance risks, and improve billing workflows with expert medical billing and revenue cycle support. Improve HIPAA Compliance   The Texas Layer: Where HB 300 Fits In Here’s what most national guides skip entirely. Texas House Bill 300 (Texas Health & Safety Code Chapter 181) sits on top of both federal rules and goes further than either alone. It applies to a broader range of entities than HIPAA, treats mental health and substance use records as “Super-Confidential Information” requiring explicit authorization, and requires notifying the Texas Attorney General if a breach affects 250 or more Texas residents. A Texas behavioral health practice handling SUD treatment isn’t managing two overlapping behavioral health privacy laws — it’s managing three.   What Changed in 2024 In February 2024, HHS and SAMHSA finalized a rule aligning Part 2 more closely with HIPAA, as required by the CARES Act. It took effect April 16, 2024, with full compliance required by February 16, 2026. Among the changes: a single patient consent can now cover future treatment, payment, and operations disclosures instead of requiring consent each time, and recipients can generally redisclose Part 2 records the way HIPAA permits, in most cases. It narrows the gap with HIPAA — it doesn’t erase it, and HB 300 obligations remain unaffected either way.   Practical Compliance Checklist Getting behavioral health HIPAA compliance right in Texas means –  Confirm whether your practice actually meets Part 2’s “federally assisted program” definition Update consent forms to reflect the 2024 single-consent changes ahead of the February 2026 deadline Make sure EHR systems can segment SUD records appropriately Train front-line staff on all three layers — HIPAA, Part 2, and HB 300 — not just HIPAA alone Handle verbal consent revocations correctly under Part 2, even when HB 300 or HIPAA would expect something in writing   Why Choose Acuity Health Solutions Behavioral health compliance in Texas isn’t a one-law problem. Acuity Health Solutions team understands how HIPAA, 42 CFR Part 2, and HB 300 interact in practice — not just in theory — and helps practices build documentation and consent processes that hold up across all three. Talk To Our Team about your compliance program.   Conclusion For most healthcare providers, HIPAA is the only privacy framework they ever need to think about closely. Texas behavioral health practices treating substance use disorders don’t have that luxury — HIPAA, 42 CFR Part 2, and HB 300 all apply at once, each with its own consent rules, disclosure limits, and deadlines to track. The 2024 Part 2 update makes some of this easier, but it doesn’t collapse three frameworks into one. The practices that stay out of trouble are the ones that build consent forms,  workflows, and staff training around all three layers from the start, rather than retrofitting compliance after a records request goes wrong. Get a Free Billing Assessment Frequently Asked Questions Does 42 CFR Part 2 apply to every behavioral health practice in Texas? No — only federally assisted programs providing SUD diagnosis, treatment, or referral. Many practices fall outside it entirely. Does the 2024 Part 2 update mean it’s now the same as HIPAA?  No — it narrows some gaps, like allowing single consent for TPO, but Part 2 remains stricter and narrower in scope than HIPAA. How does HIPAA behavioral health guidance differ from 42 CFR Part 2?  It adds a state-level layer on top of both federal frameworks. No — only federally assisted programs providing SUD diagnosis, treatment, or referral. Many practices fall outside it entirely.  No — it narrows some gaps, like allowing single consent for TPO, but Part 2 remains stricter and narrower in scope than HIPAA.  It adds a state-level layer on top of both federal frameworks. Helpful Links -: Texas Medicaid Behavioral Health Billing Guide(2026) Behavioral Health CPT Codes

Plastic Surgery CPT Codes: A Practice Guide to Coding, Modifiers & Denial Prevention 

Quick Answer: Plastic Surgery Billing relies on CPT codes to describe the procedure performed — rhinoplasty, breast reconstruction, panniculectomy, blepharoplasty, and similar procedures each have their own code sets. ICD-10-CM codes separately establish why the procedure was medically necessary. Whether a service is covered depends on the specific procedure, the diagnosis behind it, the documentation supporting it, and the individual payer’s policy — not on the CPT code alone. If you’ve ever had a claim denied despite using what looked like the “right” code, you already know the problem isn’t usually the code itself. It’s everything wrapped around it — the diagnosis it’s paired with, the modifier attached to it, and whether the operative note actually backs up what’s being billed. Plastic surgery sits at an unusual intersection of medicine where the same physical procedure can be entirely covered or entirely the patient’s responsibility, depending on why it was done. That’s what makes this specialty harder to bill correctly than most people expect going in.   Plastic Surgery CPT Coding at a Glance A CPT code tells the payer what was done. An ICD-10-CM code tells the payer why it was done. Neither one works well without the other, and in plastic surgery, that pairing carries more weight than in almost any other specialty — because the same CPT code can describe a covered, medically necessary procedure for one patient and a purely elective, self-pay procedure for another. Take a panniculectomy. The CPT code doesn’t change based on the patient’s reason for having it. What changes is everything around the code: the diagnosis, the documented symptoms, the history of failed conservative treatment, and whether the payer’s specific policy considers that combination medically necessary. Selecting a procedure code is really just step one. Coding Element What It Tells the Payer CPT What procedure was performed ICD-10-CM Why the procedure was performed Modifier How, or under what circumstances, it was performed Documentation Evidence supporting the claim Payer Policy Whether — and under what conditions — it’s covered Miss any one of these five, and the claim is vulnerable, even if the CPT code itself was entered correctly.   Reconstructive vs. Cosmetic Plastic Surgery: Why the Distinction Matters Reconstructive procedures are performed to correct or improve function, or to address an abnormal structure caused by a congenital defect, disease, trauma, or a prior medical procedure — a mastectomy, for instance. Cosmetic procedures, by contrast, are performed primarily to improve appearance in the absence of that kind of functional or medical justification. Here’s the part that trips practices up: the same procedure type can fall into either category depending entirely on the clinical indication. It’s worth being precise here: none of this means a procedure is automatically covered just because it fits one of these categories, or automatically cosmetic because it doesn’t. Coverage always comes down to the specific indication, the supporting documentation, and the individual payer’s medical policy for that procedure. Two payers can look at an identical case and land in different places. This is also where hybrid cases come in — a single operative session that includes both a reconstructive component and a separate cosmetic component. Those cases add real billing complexity, and we’ll come back to them in detail later in this guide. Get Plastic Surgery Billing Support   Common Plastic Surgery CPT Codes by Procedure Category The codes below aren’t a complete list of everything plastic surgeons bill — that would run into the hundreds. This covers the categories that come up most often and cause the most coding questions. Breast Surgery CPT Codes CPT Code Procedure Common Use Cosmetic/Reconstructive Context Key Documentation 19318 Reduction mammoplasty Relieve symptoms of macromastia Often reconstructive when functional symptoms are documented Back/neck pain, skin breakdown, tissue weight estimates 19316 Mastopexy Breast lift Usually cosmetic unless tied to reconstruction Photos, patient goals 19325 Breast augmentation Increase breast size Typically cosmetic Informed consent, cosmetic agreement 19340/19342 Tissue expander placement/removal Staged breast reconstruction Reconstructive, post-mastectomy Operative note, staging plan 19357 Tissue expander with immediate reconstruction Breast reconstruction Reconstructive Mastectomy record, reconstruction plan 19361–19369 Various flap-based breast reconstruction Autologous tissue reconstruction Reconstructive Flap type, donor site, operative detail 19350 Nipple/areola reconstruction Post-mastectomy reconstruction Reconstructive Prior mastectomy/reconstruction history Breast reconstruction is one of the more heavily regulated areas of plastic surgery billing, largely because of a specific federal law — covered in its own section below. Rhinoplasty & Nasal Procedures CPT Code Procedure Context 30400 Primary rhinoplasty, lateral and alar cartilages/tip Often cosmetic 30410 Primary rhinoplasty, complete, including major septal repair Can be functional if septal correction is documented 30420 Primary rhinoplasty including major septal repair Frequently paired with septoplasty for breathing correction The functional-versus-cosmetic line matters enormously here. A rhinoplasty billed purely on aesthetic grounds and one billed with a documented nasal airway obstruction can use overlapping codes but lead to very different reimbursement outcomes. Eyelid & Facial Procedures CPT Code Procedure Context 15822/15823 Blepharoplasty, upper eyelid (with or without excessive skin) Reconstructive when visual field obstruction is documented 15820/15821 Blepharoplasty, lower eyelid Usually cosmetic 67904 Repair of blepharoptosis (ptosis repair) Distinct from blepharoplasty — corrects eyelid position, not excess skin Blepharoplasty and ptosis repair are frequently confused, but they’re clinically different problems with different codes — one addresses excess skin, the other addresses the eyelid’s position relative to the pupil. Abdominoplasty, Panniculectomy & Body Contouring CPT Code Procedure Context 15830 Excision of excess skin and subcutaneous tissue, abdomen (panniculectomy) Reconstructive when tied to documented skin conditions 15847 Abdominoplasty with extensive dissection (often billed with 15830) Frequently bundled — requires careful modifier use 15877 Suction-assisted lipectomy, trunk Typically cosmetic CPT 15847 in particular is a common bundling flashpoint, since it’s often performed alongside 15830 in the same operative session. Skin Grafts & Flap Procedures CPT Code Procedure Context 15100–15101 Split-thickness skin graft Reconstructive, trauma/wound-related 15200–15261 Full-thickness skin graft Reconstructive 14000–14350 Adjacent tissue transfer/rearrangement Reconstructive, defect closure Wound Repair & Scar Procedures Complex repair codes (typically in the 13100–13300 range) apply when wound closure requires more than

Behavioral Health CPT Codes Guide for Texas Providers 

If you’ve ever stared at a denied claim wondering whether you used 90834 or 90837, you’re not alone — it’s one of the most common mix-ups in behavioral health billing. This guide walks through the CPT codes Texas providers use most, what they actually cover, and where Texas Medicaid adds its own twist. Quick answer: Behavioral Health Billing in Texas relies on a mix of standard CPT codes (90791, 90832–90838, 90846–90853) for evaluation and psychotherapy, plus Texas Medicaid-specific HCPCS codes like H0031 and H2019 for certain community-based services. Getting the code, the session length, and the documentation to match is what keeps claims from bouncing back.   Evaluation Codes 90791 — Psychiatric diagnostic evaluation, no medical services. Used by therapists, psychologists, and counselors for the initial intake assessment. 90792 — Same evaluation, but with medical services included. This is the version psychiatrists and prescribing providers bill, since it covers the medical component of the assessment. Only one of these gets billed per intake, not both — and most payers won’t reimburse a second evaluation code for the same patient without a real gap in treatment.   Individual Psychotherapy Codes This is where a lot of denials happen, because these codes are entirely time-based: Code Session Length Notes 90832 30 minutes (16–37 min) Shorter sessions 90834 45 minutes (38–52 min) Most common individual session 90837 60 minutes (53+ min) Longer sessions, more heavily audited The code has to match what’s documented in the session note — not what’s typically billed, not what insurance “usually” pays for. 90837 in particular draws more payer scrutiny than the other two, simply because it reimburses more, so documentation needs to clearly support the full session length.   Add-On Codes for Medication Management Visits When a psychiatrist or prescriber does psychotherapy alongside a medical evaluation and management (E/M) visit — say, a med check plus a supportive therapy component — the psychotherapy portion gets billed as an add-on code, not a separate CPT: These always pair with an E/M code (like 99213 or 99214) — they’re never billed alone. Get Expert Behavioral Health Billing Support   Group and Family Therapy Codes 90853 — Group psychotherapy. Billed once per patient in the group, not once per group session. 90846 — Family psychotherapy without the patient present. 90847 — Family psychotherapy with the patient present.   Psychological Testing Codes For practices that do formal testing, 96130/96131 cover the evaluation and interpretation of psychological test results, while 96136/96137 cover the actual test administration and scoring. These are billed in timed units, which is a common place practices under- or over-bill without realizing it.   Texas Medicaid’s Own Codes Standard CPT codes cover most billing, but Texas Medicaid also uses HCPCS codes for certain community-based behavioral health services that fall outside typical CPT definitions — most commonly H0031 (mental health assessment) and H2019 (therapeutic behavioral services), as outlined in the TMHP Behavioral Health and Case Management Services Handbook. If your practice bills Texas Medicaid directly or through an MCO, it’s worth checking whether a service should be billed under CPT or under one of these HCPCS codes instead — using the wrong one is a quiet but common denial cause.   Telehealth Billing in Texas Behavioral health leans on virtual visits more than almost any Other Specialty, and telehealth billing has its own coding logic separate from the CPT codes above. POS 02 — Telehealth Provided Other Than in Patient’s Home. Use this when the patient is somewhere other than home during the visit — an office, a clinic, a school setting. This triggers the lower facility rate. POS 10 — Telehealth Provided in Patient’s Home. CMS added this code in 2022 specifically for patients receiving care from home. It triggers the higher non-facility rate — the same rate as an in-person office visit. These two aren’t interchangeable, and mixing them up doesn’t usually bounce the claim back as an obvious error; it just quietly pays out at the wrong rate. A 45-minute telehealth session (90834) billed with POS 02 when the patient was actually home gets reimbursed less than it should, on every single claim, without anyone necessarily noticing until someone audits the pattern. Modifier 95 goes alongside the POS code, not instead of it. It confirms the visit was real-time, interactive audio-video telehealth — payers use it to recognize the encounter as synchronous, which matters for whether it’s covered at all. Prevention: Confirm and document exactly where the patient was located at the start of every telehealth visit, and match the POS code to that location — not to habit or whatever was billed last time.   Why This Trips Practices Up The codes themselves aren’t complicated. What’s complicated is the layering: matching session time to the exact code, knowing when a code needs to be paired with an E/M visit instead of standing alone, and knowing when Texas Medicaid wants a HCPCS code instead of the CPT code a commercial payer would expect for the same service. Miss any one of these, and the claim comes back.   Why Choose Acuity Health Solutions Acuity Health Solutions coders specialize in behavioral health, with direct experience across Texas Medicaid, MCOs, and commercial payers. We match session documentation to the right code the first time — reducing the coding-related denials that eat into a practice’s time and revenue. Talk to our team about your behavioral health billing. Get a Free Billing Assessment Frequently Asked Questions What’s the difference between 90834 and 90837? Session length — 90834 covers roughly 38–52 minutes, 90837 covers 53 minutes or more, and documentation has to support whichever is billed. Can 90791 and 90792 both be billed for the same patient? No — only one applies, depending on whether medical services were part of the evaluation. Do add-on codes like 90833 get billed alone? No, they must always accompany an E/M code from the same visit. Does Texas Medicaid use different codes than commercial insurance? Mostly the same CPT codes, but certain community-based services use