|Arizona reimbursement for telepsychiatry|
Arizona Telehealth law 2015 for rural areas but expanding to whole state in 2018
AHCCCS Telehealth Manual March 2015
Arizona reimburses for telepsychiatry.
AHCCCS covers medically necessary services provided via telemedicine.
Service delivery via telemedicine can be in one of two modes:
Real time means the interactive, two-way transfer of information and medical data, which
occurs at two sites simultaneously: the hub site and the spoke site.
Hub site means the location of the telemedicine consulting provider, which is considered
the place of service.
Spoke site means the location where the recipient is receiving the telemedicine service.
Diagnostic, consultation, and treatment services are delivered through interactive audio,
video, and/or data communication.
Store-and-forward means transferring medical data from one site to another through the
use of a camera or similar device that records (stores) an image that is sent (forwarded)
via telecommunication to another site for consultation.
The following medical services are covered, both real time and store-and-forward:
Pediatrics and pediatric subspecialties
Surgery follow-up and consultations
Behavioral health services are covered for Title XIX (Medicaid) and Title XXI (KidsCare)
Covered behavioral health services include (real time only):
Diagnostic consultation and evaluation
Psychotropic medication adjustment and monitoring
Individual and family counseling
Non-emergency transportation to and from the spoke site to receive a medically necessary
consultation or treatment is covered for Title XIX recipients only.
Conditions and limitations
At the time of service delivery via real time telemedicine, the recipient’s PCP, attending
physician, or other medical professional employed by the PCP or attending physician
who is familiar with the recipient’s condition must be present with the recipient.
Other medical professionals include registered nurses; licensed practical nurses; clinical
nurse specialists; registered nurse midwives; registered nurse practitioners; physician
assistants; physical, occupational, speech, and respiratory therapists; and a trained
telepresenter familiar with the recipient’s medical condition.
For real time behavioral health services, the recipient’s physician, case manager,
behavioral health professional, or telepresenter must be present with the recipient during
All services provided via telemedicine must be reasonable, cost effective and medically
necessary for the diagnosis or treatment of a recipient’s medical or behavioral health
Services must be billed on a CMS 1500 claim form using the “GT” modifier to designate the
service being billed as a telemedicine service.
Services are billed by the consulting provider.
Unlisted or unspecified services
Procedure codes for unspecified or unlisted procedures (identified by CPT codes ending in
“99”) should only be billed in situations where no other code adequately describes the
Providers who bill procedure codes for unspecified or unlisted procedures must describe the
service rendered and identify the service in the procedure or operative report.
Claims with such procedure codes are subject to Medical Review.
For more information visit the ATA Wiki page for Arizona here
|Last Updated on Tuesday, 21 June 2016 11:43|