Arizona guide to reimbursement for telehealth services PDF Print E-mail

GUIDE TO TELEHEALTH REIMBURSEMENT IN ARIZONA

Arizona reimburses for telepsychiatry and other services.  Arizona Telehealth law expanded to include entire state in 2016.  For more information see the AHCCCS Telehealth Manual from March 2015

 

Telemedicine:

 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:

 Cardiology

 Dermatology

 Endocrinology

 Hematology/oncology

 Home health

 Infectious diseases

 Neurology

 Obstetrics/gynecology

 Oncology/radiation

 Ophthalmology

 Orthopedics

 Pain clinic

 Pathology

 Pediatrics and pediatric subspecialties

 Radiology

 Rheumatology

 Surgery follow-up and consultations

 Behavioral health services are covered for Title XIX (Medicaid) and Title XXI (KidsCare)

recipients.

 Covered behavioral health services include (real time only):

 Diagnostic consultation and evaluation

 Psychotropic medication adjustment and monitoring

 Individual and family counseling

 Case management

 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

the consultation.

 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

condition.

 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

service performed.

 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.

 

 

 

 

 

 

 

 

 

 

 

Last Updated on Thursday, 10 August 2017 14:07