Alabama

Last updated 06/22/2023

Consent Requirements

Providers must obtain prior written or verbal consent from the recipient before services are rendered.

Telemedicine services provided to minors under the age of medical consent must have a parent or legal guardian attend the telemedicine visit.

SOURCE: AL Medicaid, Telemedicine Policy, 5/26/23, Effective June 1, 2023, (Accessed Jun. 2023).

Physician is and 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.

SOURCE: AL Medicaid Management Information System Provider Manual, Physician Service (ch. 28, p. 17). Apr. 2023. (Accessed Jun. 2023).

Providers enrolled in Medicaid with specialty type 931, offering Applied Behavior Analysis and Positive Behavior Support (PBS) Services must must obtain prior consent from the recipient before services are rendered. A sample recipient consent form is attached to the Telemedicine Service Agreement(see manual for more details).

SOURCE: AL Medicaid Management Information System Provider Manual, Therapy (Occupational, Physical, Speech, and Applied Behavior Analysis), (Ch. 37, p. 16). Apr. 2023. (Accessed Jun. 2023).

Remote Patient Monitoring (RPM) Services

A practitioner must obtain patient consent before furnishing or billing RPM services. Consent may be verbal or written but must be documented in the medical record, and includes informing them about:

• The availability of RPM services and applicable cost sharing
• That only one practitioner can furnish and be paid for RPM services during a calendar month
• The right to stop RPM services at any time (effective at the end of the calendar month)

Informed patient consent by the recipient or caregiver, when appropriate, must be obtained prior to rendering RPM services or if the patient chooses to change the practitioner who will render the services.

SOURCE: AL Medicaid Management Information System Provider Manual, Remote Patient Monitoring (Ch. 111, Pg. 3), Apr. 2023. (Accessed Jun. 2023).

For Rehabilitative Services — ASD, DMH, DHR, DYS, DCA —  the treatment provider who delivers the service to a recipient shall ensure that the following written information is provided to the recipient in a form and manner which the recipient can understand, using reasonable accommodations when necessary, that:

• S/he retains the option to refuse the telehealth service at any time without affecting the right to future care or treatment and without risking the loss or withdrawal of any program benefits to which the recipient would otherwise be entitled;
• Alternative options are available, including in-person services, and these options are specifically listed on the recipient’s informed consent statement;
• All existing confidentiality protections apply to the telemedicine consultation (this applies to physicians only);
• All existing confidentiality protections apply to the telehealth treatment services provider by treatment providers;
• S/he has access to all medical information resulting from the telemedicine consultation/telehealth treatment services as provided by law for patient access to his/her medical records;
• The dissemination of any recipient identifiable images or information from the telemedicine consultation/telehealth treatment services to anyone, including researchers, will not occur without the written consent of the recipient;
• S/he has a right to be informed of the parties who will be present at each end of the telemedicine consultation/telehealth treatment services and s/he has the right to exclude anyone from either site; and
• S/he has a right to see an appropriately trained staff or employee in-person immediately after the telemedicine consultation/telehealth treatment service if an urgent need arises, or to be informed ahead of time that this is not available.

The treatment provider providing the telehealth treatment service, or staff at the recipient site, shall retain the signed statement and the statement must become a part of the recipient’s medical record. A copy of the signed informed consent must also be given to the recipient and documented in the medical record.

SOURCE: AL Medicaid Management Information System Provider Manual, Rehabilitative Services – DMH, DHR, DYS, DCA(105, p. 11-12).  Apr. 2023 & AL Medicaid Management Information System Provider Manual, Rehabilitative Services (ASD) – DMH (Ch. 110, p. 18).  Apr. 2023. (Accessed Jun. 2023).

Family Planning

For any telephonic encounter a verbal consent is required. A recipient consent for services must be obtained at each Family Planning visit.

SOURCE:  AL Medicaid Management Information system Provider Manual, Appendix C Family Planning, Apr. 2023, C-1, (Accessed Jun. 2023).

Last updated 06/21/2023

Definitions

Telehealth medical services means “digital health, telehealth, telemedicine, and the applicable technologies and devices used in the delivery of telehealth. The term does not include incidental communications between a patient and a physician.

• Digital Health is defined as “the delivery of health care services, patient education communications, or public health information via software applications, consumer devices, or other digital media.”
• Telehealth is defined as “the use of electronic and telecommunications technologies, including devices used for digital health, asynchronous and synchronous communications, or other methods, to support a range of medical care and public health services.”
• Telemedicine is defined as “a form of telehealth referring to the provision of medical services by a physician at a distant site to a patient at an originating site via asynchronous or synchronous communications, or other devices that may adequately facilitate and support the appropriate delivery of care. The term includes digital health but does not include incidental communications between a patient and a physician.”

SOURCE: AL Medicaid, Telemedicine Policy, 5/26/23, Effective June 1, 2023, (Accessed Jun 2023).

There is no explicit definition of “telemedicine” given in state Medicaid policy. However, the provider manual states, “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).”

SOURCE: AL Medicaid Management Information System Provider Manual, Physician Services (28, p.17). Apr. 2023. (Accessed Jun. 2023).

Last updated 06/22/2023

Email, Phone & Fax

Providers meeting the telemedicine provider requirements listed above must append the modifier GT to all procedure codes billed for covered telemedicine services via audio and visual telecommunications. Additional modifiers may be required; see the chapter of the Provider Billing Manual that describes services provided for further information. At this time, reimbursement for services provided through telemedicine via audio and audio and video telecommunications will be paid at parity to those services provided face-to-face. Medicaid will continue to monitor and reevaluate, if deemed necessary. On October 1, 2023, new rates for audio-only telecommunications will be established.

Providers should place a FQ modifier on an audio-only telemedicine claim to designate that the claim was delivered through audio-only telecommunications.

SOURCE: AL Medicaid, Telemedicine Policy, 5/26/23, Effective June 1, 2023, (Accessed Jun 2023).

Medicaid will continue to allow audio-only telecommunications to be reimbursed at parity for dates of services rendered through September 30, 2023. On October 1, 2023, new rates for audio-only telecommunications will be established.

This audio-only telecommunications method can only be used in lieu of the audio and video telecommunications method where telemedicine services are approved by Medicaid.

Providers must place the ‘FQ’ modifier on the claim to designate that the service was rendered via an audio-only telecommunications method.

SOURCE: AL Medicaid, Provider Alert, Telemedicine Delivery of Services, 4/26/23, (Accessed Jun. 2023).

Covered services does not include a telephone conversation, electronic mail message, or facsimile transmission between the physician, recipient, or a consultation between two physicians.

SOURCE: AL Medicaid Management Information System Provider Manual, Physician Service (ch. 28, p.17). Apr. 2023. (Accessed Jun. 2023).

Telephone consultations are not covered.

SOURCE:  AL Admin. Code r. 560-X-6-.14., p. 27 & 31. (Accessed Jun. 2023).

Therapy Services

Services must be administered via an interactive audio and video telecommunications system which permits two-way communication between the distant site provider and the origination site where the recipient is located (this does not include a telephone conversation, electronic mail message, or facsimile transmission between the provider, recipient, or a consultation between two providers).

SOURCE: AL Medicaid Management Information System Provider Manual, Therapy Services, Apr. 2023, pg. 37-16, (Accessed Jun. 2023).

Rehabilitative Services (ASD) – DMH

Video telecommunication … does not include a telephone conversation, electronic mail message, or facsimile transmission between the treatment provider, recipient, or a consultation between two treatment providers.

SOURCE:  AL Medicaid Management Information system Provider Manual, Rehabilitative Services (ASD) – DMH, Apr. 2023, 110-16, (Accessed Jun. 2023).

Family Planning

For any telephonic encounter a verbal consent is required. A recipient consent for services must be obtained at each Family Planning visit.

SOURCE:  AL Medicaid Management Information system Provider Manual, Appendix C Family Planning, Apr. 2023, C-1, (Accessed Jun. 2023).

Last updated 06/22/2023

Live Video

POLICY

Services must be administered via an interactive audio or audio and video telecommunications system which permits two-way communication between the distant site provider and the site where the recipient is located (this does not include electronic mail message or facsimile transmission between the provider and recipient).

Providers meeting the telemedicine provider requirements listed above must append the modifier GT to all procedure codes billed for covered telemedicine services via audio and visual telecommunications. Additional modifiers may be required; see the chapter of the Provider Billing Manual that describes services provided for further information. At this time, reimbursement for services provided through telemedicine via audio and audio and video telecommunications will be paid at parity to those services provided face-to-face. Medicaid will continue to monitor and reevaluate, if deemed necessary.

SOURCE: AL Medicaid, Telemedicine Policy, 5/26/23, Effective June 1, 2023, (Accessed Jun 2023).

Alabama Medicaid reimburses for live video for certain services and under certain circumstances.

SOURCE: AL Medicaid Management Information System Provider Manual, Physician Services (28-17). Apr. 2023, (Accessed Jun. 2023).

Telemedicine: Telemedicine services are covered for limited specialties and under special circumstances. Refer to the Alabama Medicaid Provider Manual, Chapter 28 for details on coverage.

SOURCE:  AL Admin. Code r. 560-X-6-.14(f)(5), p. 31. (Accessed Jun. 2023).

Therapy Services

Services must be administered via an interactive audio and video telecommunications system which permits two-way communication between the distant site provider and the origination site where the recipient is located (this does not include a telephone conversation, electronic mail message, or facsimile transmission between the provider, recipient, or a consultation between two providers).

Telemedicine health care providers shall ensure that the telecommunication technology and equipment used at the recipient site and at the provider site, is sufficient to allow the provider 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.

SOURCE: AL Medicaid Management Information System Provider Manual, Therapy Services, Apr. 2023, pg. 37-16, (Accessed Jun. 2023).

Rehabilitative Services (ASD) – DMH

If any of these services are provided via video telecommunication, it must be provided in the most private available setting and must be conducted through a two-way interactive audio and video technology system that permits two-way communication between the treatment provider and the Medicaid recipient.

SOURCE:  AL Medicaid Management Information system Provider Manual, Rehabilitative Services (ASD) – DMH, Apr. 2023, 110-16, (Accessed Jun. 2023).

ELIGIBLE SERVICES/SPECIALTIES

Services rendered via telecommunication system must be provided by a provider who is licensed, registered, or otherwise authorized to engage in his or her healthcare profession in the state where the patient is located. Per Alabama law, the provision of telemedicine medical services is deemed to occur at the patient’s originating site within this state.

Services must be within the provider’s scope of license.

Services must be provided to a recipient that is an established patient of the provider or practice or due to a referral made by a patient’s licensed physician with whom the patient has an established physician-patient relationship, in the usual course of treatment of the patient’s existing health condition.

A covered telemedicine service will count as part of each recipient’s benefit limit of 14 annual physician office visits currently allowed, if applicable. Further, nothing in this policy expands or grants any authority outside that authority granted to the provider by their respective licensure board or by federal or state law.

Specific covered services list provided in manual by provider type.

Services NOT Eligible for Reimbursement for Telemedicine Services

Common examples of services via telemedicine not considered for reimbursement (not exhaustive):

• Chart reviews
• Electronic mail messages (between providers and recipients)
• Facsimile transmissions (between providers and recipients)
• Consultation between two providers
• Internet based communications that are not HIPAA-compliant or secure
• Services not directly provided by an enrolled provider or by office staff
• Services not normally charged for during an office visit
• Services not specifically listed in Provider Billing Manual chapters
• Communication that is not secure or HIPAA-compliant (e.g., Skype, FaceTime)

Exceptions may be made to the lists for providers and services not reimbursable under this policy in the event of a public health emergency, however, separate guidance would be issued in those instances.

SOURCE: AL Medicaid, Telemedicine Policy, 5/26/23, Effective June 1, 2023, (Accessed Jun 2023).

BMI Recordings for Telemedicine Visits

The BMI recording will continue to be required for office visits including the telemedicine visits. The BMI is required at least once per calendar year on all claims with procedure codes 99201-99205, 99211- 99215, and 99241-99245 and EPSDT procedure codes 99382-99385 and 99392-99395. To be eligible for reimbursement for the telemedicine visits, the provider must file the claim with the appropriate place of service and modifier GT for audio and visual telecommunications or FQ for audio only telecommunications.

During telemedicine visits, providers should use subjective data to calculate the BMI which can include providers asking the recipient for his or her height and weight during the visit. The BMI should be calculated, based on the information provided by the recipient, and appended to the claim for reimbursement. The BMI should also be documented in the recipient’s medical record.

SOURCE: AL Medicaid, All Provider Alert, BMI Recording for Telemedicine Visits, 6/7/23, (Accessed Jun. 2023).

Alabama Medicaid reimburses for the following services when billed with a GT modifier:

• Consultations;
• Office or other outpatient visits;
• Individual psychotherapy;
• Psychiatric diagnostic services;
• Neurobehavioral status exams.

Procedure codes for Applied Behavior Analysis therapy is also covered.

SOURCE: AL Medicaid Management Information System Provider Manual, Physician Services (Ch. 28, p.17). Apr. 2023. (Accessed Jun. 2023).

Telemedicine services are covered for limited specialties and under special circumstances.

SOURCE:  AL Admin. Code r. 560-X-6-.14(f)(5). (Accessed Jun. 2023).

Rehabilitation services that are delivered face to face can either be in person or via telemedicine/telehealth, as approved by the Alabama Medicaid Agency.  Telemedicine/telehealth may also be used to deliver Nursing Assessment and Care when certain conditions are met.

SOURCE: AL Medicaid Management Information System Provider Manual, Rehabilitative Services (ch. 105, p. 1 & 60). Apr. 2023. (Accessed Jun. 2023).

An appropriately trained staff or employee familiar with the recipient’s treatment plan or familiar to the recipient must be immediately available in-person to the recipient receiving a telehealth service to attend to any urgencies or emergencies that may occur during the service. “Immediately available” means the staff or employee must be either in the room or in the area outside the telehealth room in easy access for the recipient. If the recipient chooses to waive this requirement, the health care provider administering the telehealth service shall document this fact in the medical record.

SOURCE: AL Medicaid Management Information System Provider Manual, Rehabilitative Services – DMH, DHR, DYS, DCA (105, p. 11).  Apr. 2023. (Accessed Jun. 2023).

ABA Therapy Services

Telemedicine health care providers shall ensure that the telecommunication technology and equipment used at the recipient site and at the provider site, is sufficient to allow the provider to appropriately evaluate, diagnose, and/or treat the recipient for services billed to Medicaid.

SOURCE: AL Medicaid Management Information System Provider Manual, Therapy Services, Apr. 2023, pg. 37-16, (Accessed Jun. 2023).

Rehabilitative Services (ASD) – DMH

Effective (date TBD) the end of the public health emergency transition period please follow the guidelines below. Until further notice continue to bill the currently approved codes (as posted on the Alabama Medicaid Agency website with the ‘02’ and ‘CR’ modifiers—your State Agency provider will notify you when to begin utilizing the codes, modifier and processes).

Certain codes are only approved for the use of telehealth billing.  See manual.

SOURCE:  AL Medicaid Management Information system Provider Manual, Rehabilitative Services (ASD) – DMH, Apr. 2023, 110-15, (Accessed Jun. 2023).

ELIGIBLE PROVIDERS

Telemedicine Provider Requirements:

• Providers must submit the Telemedicine Service Agreement/Certification to Medicaid’s fiscal agent. The form is located on the Medicaid website at: www.medicaid.alabama.gov.
• Providers must be enrolled with Medicaid with a specialty type of 931 (Telemedicine Service).
• Providers must identify themselves to the recipient with their credentials and name at the time of service.
• Providers must obtain prior written or verbal consent from the recipient before services are rendered.
• Telemedicine services may only be provided as a result of a patient’s request, part of an expected follow up, or a referral from the patient’s licensed physician with whom the patient has an established patient-physician relationship.
• Services rendered via telecommunication system must be provided by a provider who is licensed, registered, or otherwise authorized to engage in his or her healthcare profession in the state where the patient is located. Per Alabama law, the provision of telemedicine medical services is deemed to occur at the patient’s originating site within this state.
• Services must be within the provider’s scope of license.
• Services must be provided to a recipient that is an established patient of the provider or practice or due to a referral made by a patient’s licensed physician with whom the patient has an established physician-patient relationship, in the usual course of treatment of the patient’s existing health condition.
• Telemedicine services provided to minors under the age of medical consent must have a parent or legal guardian attend the telemedicine visit.
• Only the provider rendering the services via telemedicine may submit for reimbursement for services.
• Providers must indicate an in-state or qualifying bordering state site of practice address from which telemedicine services will be provided.

Provider Types Eligible

• Physicians
• Physician Assistants
• Psychologists
• Associate Licensed Counselors
• Licensed Master Social Workers
• Licensed Psychological Technicians
• Optometrists
• Early Intervention
• Pharmacists/Pharmacies
• Certified Registered Nurse Practitioners (CRNPs)
• Rehabilitative Option Providers
• Licensed Professional Counselors
• Licensed Marriage and Family Therapist and Associates
• Licensed Independent Clinical Social Workers
• Speech Therapists
• Applied Behavior Analysts
• Children’s Rehabilitation Service
• Targeted Case Management

Provider Types NOT Eligible for Telemedicine Reimbursement

• Physical Therapists
• Occupational Therapists
• DME suppliers
• Ambulance providers
• Chiropractors
• Home Infusion
• Laboratory

SOURCE: AL Medicaid, Telemedicine Policy, 5/26/23, Effective June 1, 2023, (Accessed Jun 2023).

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:

• Physicians must be enrolled with Alabama Medicaid with a specialty type of 931 (Telemedicine Service)
• Physician must submit the telemedicine Service Agreement/Certification form
• 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.

SOURCE: AL Medicaid Management Information System Provider Manual, Physician Services (ch. 28, p.17) Apr. 2023 (Accessed Jun. 2023).

For ABA therapy or PBS services listed above provided via telemedicine, enrolled providers 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:

• Providers must be enrolled with Alabama Medicaid with a specialty type of 931 (Telemedicine Service).
• To be enrolled with the 931 specialty, providers must submit the Telemedicine Service Agreement/Certification form which is located on the Medicaid website at: www.medicaid.alabama.gov. Electronic signatures will be acceptable for the telemedicine agreement. The agreement may be uploaded through the provider web portal along with a request to add the 931 specialty. See Chapter 2 – Becoming a Medicaid Provider for further information.
• Providers must obtain prior consent from the recipient before services are rendered. A sample recipient consent form is attached to the Telemedicine Service Agreement.

SOURCE: AL Medicaid Management Information System Provider Manual, Therapy Services, Apr. 2023, pg. 37-15 to 16, (Accessed Jun. 2023).

Telemedicine providers who render maternity-related services are required to sign a Non-Delivering Telemedicine DHCP Participation agreement with at least one of the Alabama Coordinated Health Networks(ACHNs) in order to receive reimbursement from Medicaid. Refer to Chapter 28 of the Provider Billing Manual to determine further requirements and procedure codes allowed for telemedicine services.

SOURCE: AL Medicaid Management Information System Provider Manual, Alabama Coordinated Health Network (ACHN) Primary Care Physician (PCP) and Delivering Healthcare Professional (DHCP) Billing, (Manual Ch. 40-p. 33). Apr. 2023), (Accessed Jun. 2023).

Rehabilitation services that are delivered face to face can either be in person or via telemedicine/telehealth, as approved by the Alabama Medicaid Agency.

SOURCE: AL Medicaid Management Information System Provider Manual, Rehabilitative Services – DMH, DHR, DYS, DCA(105, p. 1).  Apr. 2023. (Accessed Jun. 2023).

The face-to-face encounter required for the ordering of home health services may be conducted using telehealth systems.

SOURCE: AL Medicaid Management Information System Provider Manual, Home Health (17-p. 2) Apr. 2023, (Accessed Jun. 2023).

The required face-to-face visit may be conducted using telehealth systems.

SOURCE: AL Medicaid Management Information System Provider Manual, Durable Medical Equipment, 14-10,  Apr. 2023. (Accessed Jun. 2023).

Therapy Services

The provider shall maintain appropriately trained staff, or employees, familiar with the recipient’s treatment plan, immediately available in-person to the recipient receiving a telemedicine service to attend to any urgencies or emergencies that may occur during the session. The provider shall implement confidentiality protocols that include, but are not limited to:

• specifying the individuals who have access to electronic records; and
• usage of unique passwords or identifiers for each employee or other person with access to the client records; and
• ensuring a system to prevent unauthorized access, particularly via the Internet; and
• 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.

SOURCE: AL Medicaid Management Information System Provider Manual, Therapy Services, Apr. 2023, pg. 37-16, (Accessed Jun. 2023).

Rehabilitative Services (ASD) – DMH

All services (including those rendered via teleconference with a direct service or consultation recipient) must be rendered by an approved Medicaid treatment provider (operating within their scope of practice) as outlined in Section 110.1.1.

The distant site is the location of the treatment provider providing the telehealth professional services. For physicians, telemedicine can be provided within or outside of the state of Alabama as long as the physician has an Alabama license and is enrolled as an Alabama Medicaid provider. For all other treatment providers, treatment services can only be provided by a treatment provider located within the state of Alabama.

SOURCE:  AL Medicaid Management Information system Provider Manual, Rehabilitative Services (ASD) – DMH, Apr. 2023, 110-16, (Accessed Jun. 2023).

ELIGIBLE SITES

The following are required for the origination site where the patient is located:

• The site provider shall ensure that the telecommunication technology and equipment used at the origination site is HIPAA compliant and is sufficient to allow the appropriate evaluation, diagnosis, and/or treatment of the patient.
• The site provider shall implement protocols that ensure the same confidentiality of the telemedicine visit as for in-person visits.
• Regardless of the location of the recipient, it is the provider’s responsibility to ensure the telemedicine visit meets all required HIPAA rules and regulations regarding telemedicine visits.

The following sites are recognized by Medicaid as origination sites:

• Physician and practitioner offices
• Hospitals
• Rural Health Clinics (RHCs)
• Federally Qualified Health Centers (FQHCs)
• Hospital-based or CAH-based Renal Dialysis Centers (including satellites)
• Skilled Nursing Facilities (SNFs)
• Community Mental Health Centers (CMHCs)
• Renal Dialysis Facilities
• Mobile Stroke Units
• Alabama Department of Public Health

Nothing in this section is meant to prohibit telemedicine services to a recipient in their home. A recipient’s home should not be considered an origination site entitled to receive an origination site fee.

SOURCE: AL Medicaid, Telemedicine Policy, 5/26/23, Effective June 1, 2023, (Accessed Jun 2023).

For rehabilitative services, the origination site for treatment services can be delivered in any setting that is convenient for both the family and staff member, that affords an adequate therapeutic environment, and that protects the recipient’s rights to privacy and confidentiality. In order for providers to qualify for Medicaid reimbursement for telehealth services, the origination site must be located in the state of Alabama.

The distant site is the location of the treatment provider providing the telehealth professional services. For physicians, telemedicine can be provided within or outside of the state of Alabama as long as the physician has an Alabama license and is enrolled as an Alabama Medicaid provider. For all other treatment providers, treatment services can only be provided by a treatment provider located within the state of Alabama.

SOURCE: AL Medicaid Management Information System Provider Manual, Rehabilitative Services (105-9). Apr. 2023. (Accessed Jun. 2023).

Rehabilitative Services (ASD) – DMH

The origination site for treatment services can be delivered in any setting that is convenient for both the recipient/family and staff member, that affords an adequate therapeutic environment, and that protects the recipient’s rights to privacy and confidentiality. In order for providers to qualify for Medicaid reimbursement for telehealth services, the origination site must be located in the state of Alabama.

SOURCE:  AL Medicaid Management Information system Provider Manual, Rehabilitative Services (ASD) – DMH, Apr. 2023, 110-16, (Accessed Jun. 2023).

Targeted Case Management

02 Place of Service code (telehealth – Services provided through telecommunication technology) is listed in the manual.

SOURCE: AL Medicaid Management Information System Provider Manual, Targeted Case Management, Ch. 106-27, Apr. 2023, (Accessed Jun. 2023).

GEOGRAPHIC LIMITS

For rehabilitative services, the distant site may be located outside of Alabama as long as the physician has an Alabama license and is enrolled as an Alabama Medicaid provider.

SOURCE: AL Medicaid Management Information System Provider Manual, Rehabilitative Services, (105-9). Apr. 2023 & Rehabilitative Services (ASD) – DMH, Apr. 2023, 110-16, (Accessed Jun. 2023).

FACILITY/TRANSMISSION FEE

Effective April 1, 2020, Medicaid pays an origination site facility fee of $20.00. The origination fee will be limited to one per date of service per recipient and may be billed by all of the providers listed above under Origination Sites.

No origination site facility fee will be paid for an origination site not listed above.

Providers must bill the procedure code Q3014, telemedicine origination site facility fee, on a CMS-1500 or UB-04 claim.

Federally Qualified Health Centers and Rural Health Clinics should bill Q3014 independent of the encounter rate on a CMS-1500 claim form.

Note: If a Medicaid-enrolled provider performs another medically necessary service(s), the provider may bill for the covered service(s) in addition to providing his/her facility as an origination site and be eligible for reimbursement for the origination site facility fee and the other medically necessary service(s).

SOURCE: AL Medicaid, Telemedicine Policy, 5/26/23, Effective June 1, 2023, (Accessed Jun. 2023).

The Alabama Medicaid Agency (Agency) will begin paying an origination site facility fee of $20.00. The origination fee will be limited to one per date of service per recipient.  Federally Qualified Health Centers and Rural Health Clinics should bill Q3014 independent of the encounter rate on a CMS-1500 claim form.

SOURCE: AL Medicaid Agency, Alert – Telemedicine Origination Site Facility Fee, Mar. 13, 2020, (Accessed Jun. 2023).

AL Medicaid reimburses providers for origination site fees for covered telemedicine services. The origination fee is limited to one per date of service per recipient.

SOURCE: AL Medicaid Management Information System Provider Manual, Physician Services (ch. 28, p. 17). Apr. 2023. (Accessed Jun. 2023).

The telemedicine origination site and/or transmission fees is not reimbursable under the Rehabilitative Services program.

SOURCE:  AL Medicaid Management Information system Provider Manual, Rehabilitative Services (ASD) – DMH, Apr. 2023, 110-18, (Accessed Jun. 2023).

Last updated 06/22/2023

Miscellaneous

Telemedicine health care providers shall ensure that the telecommunication technology and equipment used is sufficient to allow the health care provider to appropriately evaluate, diagnose, and/or treat the recipient for services billed to Medicaid and is HIPAA compliant.

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 implement confidentiality protocols that include, but are not limited to:

• specifying the individuals who have access to electronic records;
• usage of unique passwords or identifiers for each employee or other person with access to the client records;
• ensuring a system to prevent unauthorized access, particularly via the internet; and
• ensuring a system to routinely track and permanently record access to such electronic medical information.

These protocols and guidelines must be available for inspection at the telemedicine site and to Medicaid upon request.

Documentation Requirements

Providers shall document in the medical record detailed information of the telemedicine visits including, but not limited to:

• Identification of the patient.
• Identification of parent or legal guardian attending the telemedicine visit if recipient is under the age of medical consent.
• Physical location of the patient, including the city and state.
• The medical record documentation must accurately reflect the services rendered and the level of medical decision making to substantiate the procedure code billed.
• The same “in” and “out” documentation is required for telemedicine as is required for current services with incremental timeframes provided in person.
• Identification of the provider including credentials.
• Patient’s consent for the use of telemedicine delivery of health care services. This consent must be documented in the recipient’s medical record.
• Condition for which the care is being provided.
• Medical necessity and appropriateness of services billed.
• Follow up care needed.
• Other relevant details of the visit.

Prior authorization is not required for services to be delivered via telemedicine, though prior authorization may be required for the individual procedure codes billed. Refer to the Provider Billing Manual chapter that describes the service provided for prior authorization requirements.

Prescribing Medications

In accordance with Alabama’s Telemedicine Law, an enrolled provider may prescribe a legend drug, medical supplies, or a controlled substance via telemedicine if the prescriber is authorized to do so under state and federal law. However, a prescription for a controlled substance may only be issued via telemedicine if:

• The telemedicine visit includes synchronous audio or audio-visual communication using HIPAA compliant equipment with the prescriber;
• The prescriber has had at least one in-person encounter with the patient within the preceding 12 months; and
• The prescriber has established a legitimate medical purpose for issuing the prescription within the preceding 12 months.

SOURCE: AL Medicaid, Telemedicine Policy, 5/26/23, Effective June 1, 2023, (Accessed Jun 2023).

All procedure codes billed for telemedicine services must be billed with modifier GT.

SOURCE: AL Medicaid Management Information System Provider Manual, Physician Services (28-17), Apr. 2023, & Rehabilitative Services (105-p. 12). Apr. 2023. (Accessed Jun. 2023).

The required face-to-face visit for the initial written prescription or order for Medicaid prescriptions (including under home health services), or orders for certain medical supplies, equipment and appliances may be conducted using telehealth systems.

SOURCE: AL Admin. Code r. 560-X-6-3, p. 8  (Accessed Jun. 2023).

Billing codes for Rehabilitative Services – DMH, DHR, DYS, DCA, to be used after the covid state of emergency are listed.

In addition to modifier HE or HF, only Medicaid approved procedure codes for Telehealth billing can be billed for telemedicine services and must be billed with modifier GT (via interactive audio and video telecommunications system). The Agency will not reimburse providers for origination site or transmission fees.

SOURCE: AL Medicaid Management Information System Provider Manual, Rehabilitative Services – DMH, DHR, DYS, DCA(105, p. 12). Apr. 2023. (Accessed Jun. 2023).

Telehealth has a “place of service code” 02 for filing claims for Targeted Case Management (TCM).

SOURCE: AL Medicaid Management Information System Provider Manual, Targeted Case Mgt (106, p. 27). Apr. 2023. (Accessed Jun. 2023).

The Telemedicine Services Agreement cannot be submitted electronically.

SOURCE: AL Medicaid Management Information System Provider Manual, Becoming a Medicaid Provider, 2, p. 2. Apr. 2023. (Accessed Jun. 2023).

Recipient Signatures are not required in the following instances: …

• Treatment plan review, mental health consultation, pre-hospitalization screening, crisis intervention, family support, Assertive Community Treatment (ACT), Program for Assertive Community Treatment (PACT), and any non-face-to-face services that can be provided by telephone or telemedicine when provided by a Rehabilitation Option Provider or a physician meeting the telemedicine requirements as set forth in the Alabama Medicaid Administrative Code and the Alabama Medicaid Provider Manual. The provider must retain documentation in the medical record to show the services were rendered.

SOURCE: Alabama Admin. Code 560-X-1-.18, (Accessed Jun. 2023).

Last updated 06/22/2023

Out of State Providers

Telemedicine services may only be provided as a result of a patient’s request, part of an expected follow up, or a referral from the patient’s licensed physician with whom the patient has an established patient-physician relationship.

Services rendered via telecommunication system must be provided by a provider who is licensed, registered, or otherwise authorized to engage in his or her healthcare profession in the state where the patient is located. Per Alabama law, the provision of telemedicine medical services is deemed to occur at the patient’s originating site within this state.

Providers must indicate an in-state or qualifying bordering state site of practice address from which telemedicine services will be provided.

SOURCE: AL Medicaid, Telemedicine Policy, 5/26/23, Effective June 1, 2023, (Accessed Jun 2023).

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.

SOURCE: AL Medicaid Management Information System Provider Manual, Physician Services (ch. 28-p. 17). Apr. 2023. (Accessed Jun. 2023).

Last updated 06/22/2023

Overview

AL Medicaid reimburses live video for a specific set of services and specific provider types.  See manual for full lists.  Although asynchronous is included in the definition of telehealth and telemedicine, the telemedicine policy makes no further mention of the modality.

Remote patient monitoring is reimbursed for certain conditions and providers and when the service meets certain requirements. An entire chapter of the Medicaid manual is dedicated to remote patient monitoring instructions.

Audio-only is reimbursed currently the same as face-to-face with FQ modifier.  On October 1, 2023, new rates for audio-only telecommunications will be established.

Last updated 06/19/2023

Remote Patient Monitoring

POLICY

Remote Patient Monitoring (RPM), also known as In-home Remote Patient Monitoring, is a program that allows medical providers to monitor and manage acute and chronic health conditions while the patient is home.

SOURCE: AL Medicaid Management Information System Provider Manual, Remote Patient Monitoring (Ch. 111, Pg. 1), Apr. 2023. (Accessed Jun. 2023).

RPM services include, but are not limited to:

• Initial home assessment for RPM
• Initial setup of RPM equipment
• Instructions and education about the use of monitoring devices
• Instructing the patient/care giver on data entry
• Instructing patient on optimum symptom control
• Direct patient contact, when necessary and as indicated
• Evaluate threshold violations
• Monitoring and follow up
• Diet/nutrition education
• Needs assessing/screening
• Making referrals for care when appropriate

RPM providers must also develop a process for addressing patient noncompliance. This process should include the expected actions of the patient and the RPM provider related to initial and on-going noncompliance issues.

SOURCE: AL Medicaid Management Information System Provider Manual, Remote Patient Monitoring (Ch. 111, Pg. 3-4), Apr. 2023. (Accessed Jun. 2023).

CONDITIONS

Remote Patient Monitoring (RPM) services are available to Medicaid eligible persons with a need for daily monitoring and with a diagnosis of one or more of the following conditions:

• Diabetes
• Gestational Diabetes (effective 10/1/2022)
• Hypertension
• Congestive Heart Failure
• Pediatric Asthma (effective 10/1/2022)

An order from the recipient’s primary care physician (PCP) is required prior to the start of rendering RPM service. Orders for RPM, along with the specific parameters for daily monitoring, must be obtained from the patient’s PCP prior to evaluation and admission. The order must be documented in the medical record. Orders must be signed and dated by the ordering practitioner and must be obtained annually. Referrals for RPM may be accepted from any source, including physicians, ACHN Care Coordinators, patient or caregiver, the Health Department, hospitals, home health agencies, or community-based organizations.

A practitioner must obtain patient consent before furnishing or billing RPM services (see informed consent section for details).

SOURCE: AL Medicaid Management Information System Provider Manual, Remote Patient Monitoring (Ch. 111, Pg. 3), Apr. 2023. (Accessed Jun. 2023).

PROVIDER LIMITATIONS

Services rendered by non-physician practitioners, i.e., physician assistants, certified registered nurse practitioner, etc., must adhere to applicable guidelines, policies and procedures. Refer to Administrative Code chapters 6: Physicians and 49: Certified Register Nurse Practitioner (CRNP) for additional information.

A provider who contracts with Medicaid as an RPM provider is added to the Medicaid system with the National Provider Identifiers provided to the Agency at the time application is made. Appropriate provider specialty codes are assigned to enable the provider to submit requests and receive reimbursements for RPM related claims.

Any provider that can and is willing to pay the Alabama State Share may enroll as an RPM provider. A Memorandum of Understand (MOU) must be executed between the Medicaid Agency and the RPM provider. The MOU will outline the financial and
medical responsibilities for the Medicaid Agency and the RPM provider.

SOURCE: AL Medicaid Management Information System Provider Manual, Remote Patient Monitoring (Ch. 111, Pg. 1-2), Apr. 2023. (Accessed Jun. 2023).

OTHER RESTRICTIONS

Requirements for RPM include but not limited to:

• Ability to provide services statewide.
• Meet appropriate clinical staffing requirements.
• Provides and allows the recipients to keep user friendly, interactive audio and video technology monitoring equipment.
•  Accepts electronic submissions of referrals.
• Provides an in-home initial assessment.
• Transmits recipient data automatically in real time (a Medicare requirement).
• Reviews, intervenes and reports on the data promptly.
• Provides 24-hour-a-day, 7-day-a-week (24/7) access to physicians or other qualified health care professionals or clinical staff, to address urgent needs of recipients.
• Develops, monitors and updates a patient-centered care plan
• Ongoing, compliance monitoring.
• Program graduation, when appropriate.

Federal requirements mandate providers re-validate periodically with the Alabama Medicaid program. Providers will receive a notification when it is time to re-validate. Failure to re-validate and provide appropriate documentation to complete the enrollment process will result in an end-date being placed on the provider file. A new enrollment application must be submitted once a provider file has been closed due to failure to timely re-validate.

Medicaid will not separately reimburse for any direct care services, such as wound care, rendered by RPM providers. RPM services are restricted to the medical diagnosis outlined in section 111.2.

See manual for documentation and evaluation report requirements.

SOURCE: AL Medicaid Management Information System Provider Manual, Remote Patient Monitoring (Ch. 111, Pg. 2-4), Apr. 2023. (Accessed Jun. 2023).

Last updated 06/22/2023

Store and Forward

POLICY

Asynchronous is included in definition of telemedicine and telehealth but no further mention of it is made in telemedicine policy.

Services must be administered via an interactive audio or audio and video telecommunications system which permits two-way communication between the distant site provider and the site where the recipient is located (this does not include electronic mail message or facsimile transmission between the provider and recipient).

SOURCE: AL Medicaid, Telemedicine Policy, 5/26/23, Effective June 1, 2023, (Accessed Jun 2023).

ELIGIBLE SERVICES/SPECIALTIES

No Reference Found

GEOGRAPHIC LIMITS

No Reference Found

TRANSMISSION FEE

No Reference Found