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

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:

     1. 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. The Hub Site is where the provider is and the Spoke site is where the patient is.  Diagnostic, consultation, and treatment services are delivered through interactive audio, video, and/or data communication.

     2. 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:

     1. Cardiology

     2. Dermatology

     3. Endocrinology

     4. Hematology/oncology

     5.  Home health

     6. Infectious diseases

     7. Neurology

     8. Obstetrics/gynecology

     9. Oncology/radiation

     10.Ophthalmology

     11.Orthopedics

     12.Pain clinic

     13.Pathology

     14.Pediatrics and pediatric subspecialties

     15.Radiology

     16.Rheumatology

     17.Surgery follow-up and consultations

     18.Behavioral health services are covered for Title XIX (Medicaid) and Title XXI (KidsCare) recipients.

     19.Covered behavioral health services include (real time only):

     20.Diagnostic consultation and evaluation

     21.Psychotropic medication adjustment and monitoring

     22.Individual and family counseling

     23.Case management

     24.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

     1. 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.

     2. 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.

     3. 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.

     4. 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.

     5. Services must be billed on a CMS 1500 claim form using the “GT” modifier to designate the service being billed as a telemedicine service.

     6. Services are billed by the consulting provider.

 

 

 

 

 

 

 

 

 

 

 

 

Last Updated on Thursday, 11 October 2018 13:08