Alabama Reimbursement for Telepsychiatry PDF Print E-mail

Alabama Medicaid Management
Information System
Provider Manual

Alabama Halts requirement to see patient in person first (8/2015)

January 2014 See page 518 (Section 28-16) 

Alabama reimburses for telepsychiatry but not for the separate facility fee. 

 

Effective for dates of service 1/16/2012 and thereafter, all physicians with an Alabama license, enrolled as a provider with the Alabama Medicaid Agency, regardless of location, are eligible to participate in the Telemedicine Program to provide medically necessary telemedicine services to Alabama Medicaid eligible recipients. In order to participate in the telemedicine program: a. Physicians must be enrolled with Alabama Medicaid with a specialty type of 931 (Telemedicine Service). b. Physician must submit the Telemedicine Service Agreement/Certification form which is located on the Medicaid website at: http://medicaid.alabama.gov/documents/5.0_Resources/5.4_ Forms_Library/5.4.6_Provider_Enrollment/5.4.6_Web_Portal _App_Telemed_Servcs_Agree_1-5-12.pdf. c. Physician must obtain prior consent from the recipient before services are rendered, this will count as part of each recipient’s benefit limit of 14 annual physician office visits currently allowed. A sample recipient consent form is located on the Medicaid website at: http://medicaid.alabama.gov/documents/5.0_Resources/5.4_ Forms_Library/5.4.6_Provider_Enrollment/Fillable_Forms/5.4. 6_AL_Med_Telemedicine_Recipient_Consent_Form_Fillable _6-30-11.pdf Services must be administered via an interactive audio and video telecommunications system which permits two-way communication between the distant site physician and the origination site where the recipient is located (this does not include a telephone conversation, electronic mail message, or facsimile transmission between the physician, recipient, or a consultation between two physicians). Telemedicine health care providers shall ensure that the telecommunication technology and equipment used at the recipient site, and at the physician site, is sufficient to allow the health care physician to appropriately evaluate, diagnose, and/or treat the recipient for services billed to Medicaid. Transmissions must utilize an acceptable method of encryption adequate to protect the confidentiality and integrity of the transmission information. Transmissions must employ acceptable authentication and identification procedures by both the sender and the receiver. The provider shall maintain appropriately trained staff, or employees, familiar with the recipient’s treatment plan, immediately available inperson to the recipient receiving a telemedicine service to attend to any urgencies or emergencies that may occur during the session. The physician shall implement confidentiality protocols that include, but are not limited to:

a. specifying the individuals who have access to electronic records; and

b. usage of unique passwords or identifiers for each employee or other person with access to the client records; and

c. ensuring a system to prevent unauthorized access, particularly via the internet; and d. ensuring a system to routinely track and permanently record access to such electronic medical information These protocols and guidelines must be available to inspection at the telemedicine site, and to the Medicaid Agency upon request. Procedure codes covered for telemedicine services include; consultations (99241-99245, 99251-99255), office or other outpatient visits (99201-99205, 99211-99215), individual psychotherapy (90832 - 90838), psychiatric diagnostic (90791 - 90792), and neurobehavioral status exam (96116). All procedure codes billed for telemedicine services must be billed with modifiers GT (via interactive audio and video telecommunications system). The Agency will not reimburse providers for origination site or transmission fees

 

 

Last Updated on Friday, 17 June 2016 11:39