Last updated 06/21/2023
Definitions
“Telehealth” means the practice of health care delivery, evaluation, diagnosis, consultation, or treatment, using the transfer of health care data through audio, visual, or data communications, performed over two or more locations between providers who are physically separated from the recipient or from each other or between a provider and a recipient who are physically separated from each other.
SOURCE: AK Statute Sec. 47.05.270(e), (Accessed Jun. 2023).
“Alaska Medicaid will pay for telemedicine services delivered in the following manner:
- Interactive method: Provider and patient interact in ‘real-time’ using video/camera and/or dedicated audio conference equipment.
- Store-and-forward method: The provider sends digital images, sounds, or previously recorded video to a consulting provider at a different location. The consulting provider reviews the information and reports back his or her analysis.
- Self-monitoring method: The patient is monitored in his or her home via a telemedicine application, with the provider indirectly involved from another location.”
SOURCE: State of AK Dept. of Health and Social Svcs., Alaska Medical Assistance Provider Billing Manuals for Community Behavioral Health Services; Physician Services (5/2013); Physician Mental Health Physician Clinic (1/2/2019) (Accessed Jun. 2023).
The department will pay a provider for a telemedicine application if the provider provided the medical services through one of the following methods of delivery in the specified manner:
- Live or interactive: the service must be provided through the use of camera, video, or dedicated audio conference equipment on a real-time basis; medical services provided by a telephone that is not a part of a dedicated audio conference system or by a facsimile machine are not eligible for payment under this paragraph
- Store-and-forward: the service must be provided through the transference of digital images, sounds, or previously recorded video from one location to another to allow a consulting provider to obtain information, analyze it, and report back to the referring provider
- Self-monitoring or testing: the services must be provided by a telemedicine application based in the recipient’s home, with the provider only indirectly involved in the provision of the service.
SOURCE: AK Admin. Code, Title 7, 110.625 & Alaska Medicaid Policy Clarification: Medicaid Telehealth Coverage. Mar. 1, 2022. (Accessed Jun. 2023).
Telemedicine means the practice of health care delivery, evaluation, diagnosis, consultation, or treatment, using the transfer of medical data through audio, video, or data communications that are performed over two or more locations between providers who are physically separated from the recipient or from each other.
SOURCE: AK Admin. Code, Title 7, 12.449; 12.490; 86.090 & Sec. 110.639 (Accessed Jun. 2023).
Telehealth means practice of health care delivery, evaluation, diagnosis, consultation, or treatment, using the transfer of medical data, audio, visual, or data communications that are performed over two or more locations between providers who are physically separated from the recipient or from each other.
SOURCE: Alaska Medicaid Policy Clarification: Medicaid Telehealth Coverage. Mar. 1, 2022 (Accessed Jun. 2023).
Last updated 06/21/2023
Email, Phone & Fax
The department shall pay for all services covered by the medical assistance program provided through telehealth if the department pays for those services when provided in person, including …
- services provided through audio, visual, or data communications, alone or in any combination, or through communications over the Internet or by telephone, including a telephone that is not part of a dedicated audio conference system, electronic mail, text message, or two-way radio.
SOURCE: AK Statute Sec. 47.07.069, (Accessed Jun. 2023).
Live or interactive; to be eligible for payment under this paragraph, the service must be provided through the use of camera, video, or dedicated audio conference equipment on a real-time basis; medical services provided by a telephone that is not part of a dedicated audio conference system or by a facsimile machine are not eligible for payment.
Audio only mode: Add modifier FQ for dates of service on or after 3/1/2022.
SOURCE: Alaska Medicaid Policy Clarification: Medicaid Telehealth Coverage. Mar. 1, 2022. (Accessed Jun. 2023).
No reimbursement for telephone when not part of a dedicated audio conference system.
No reimbursement for facsimile.
No reimbursement for equipment and systems.
SOURCE: State of AK Dept. of Health and Social Svcs., Alaska Medical Assistance Provider Billing Manuals for Community Behavioral Health Services; Mental Health Physician Clinic (1/2/2019); Physician, ARNP and PA Services (5/13) (Accessed Jun. 2023).
The department will pay only for professional services for a telemedicine application of service. The department will not pay for the use of technological equipment and systems associated with a telemedicine application to render the service.
SOURCE: AK Admin Code, Title 7, 635 (Accessed Jun. 2023).
Last updated 06/21/2023
Live Video
POLICY
The department shall pay for all services covered by the medical assistance program provided through telehealth if the department pays for those services when provided in person (see Eligible Services Section below for eligible services).
The department shall adopt regulations for services provided by telehealth, including setting rates of payment. The department may set a rate of payment for a services provided through telehealth that is different from the rate of payment for the same service provided in person. The department may exclude or limit coverage or reimbursement for a service provided by telehealth, or limit the telehealth modes that may be used for a particular service, only if the department
- specifically excludes or limits the service from telehealth coverage or reimbursement by regulations adopted under this subsection;
- determines, based on substantial medical evidence, that the service cannot be safely provided using telehealth or using the specified mode; or
- determines that providing the service using the specified mode would violate federal law or render the service ineligible for federal financial participation under applicable federal law.
All services delivered through telehealth under this section must comply with the Health Insurance Portability and Accountability Act of 1996 (P.L. 104-191).
SOURCE: AK Statute Sec. 47.07.069, (Accessed Jun. 2023).
Alaska’s Medicaid program will reimburse for services “provided through the use of camera, video, or dedicated audio conference equipment on a real-time basis.”
SOURCE: AK Admin. Code, Title 7, 110.625(a)(1). (Accessed Jun. 2023).
Alaska Medicaid will pay for a covered medical service furnished through telemedicine application if the service is:
- Covered under traditional, non-telemedicine methods;
- Provided by a treating, consulting, presenting or referring provider;
- Appropriate for provision via telemedicine
Source: State of AK Dept. of Health and Social Svcs, Alaska Medical Assistance Provider Billing Manuals for Community Behavioral Health Services; Mental Health Physician Clinic (1/2/2019); Physician, PA, ARNP Services (5/13). (Accessed Jun. 2023).
The department will pay for telemedicine applications provided by a treating, consulting, presenting, or referring provider for a medical service covered by Medicaid and provided within the scope of the provider’s license. A presenting provider is only eligible to receive Medicaid payment for a live or interactive telemedicine application.
SOURCE: AK Admin. Code, Title 7, 110.630. (Accessed Jun. 2023).
The department will pay for medical services furnished through telemedicine applications as an alternative to traditional methods of delivering services to Medicaid recipients. For the provider to receive payment, the provider’s use of telemedicine applications must comply with the standards for services delivered under the Medicaid program and for the medical services provided by the type of provider, including provisions that affect the efficiency, economy and quality of service; and coverage limitations.
SOURCE: Alaska Admin Code. Title 7, Sec. 110.620. (Accessed Jun. 2023).
The department will pay a provider for a telemedicine application if the provider provided the medical services through one of the following methods of delivery in the specified manner:
- Live or interactive: the service must be provided through the use of camera, video, or dedicated audio conference equipment on a real-time basis; medical services provided by a telephone that is not a part of a dedicated audio conference system or by a facsimile machine are not eligible for payment under this paragraph
- Store-and-forward: the service must be provided through the transference of digital images, sounds, or previously recorded video from one location to another to allow a consulting provider to obtain information, analyze it, and report back to the referring provider
- Self-monitoring or testing: the services must be provided by a telemedicine application based in the recipient’s home, with the provider only indirectly involved in the provision of the service.
SOURCE: AK Admin. Code, Title 7, 110.625 & Alaska Medicaid Policy Clarification: Medicaid Telehealth Coverage. Mar. 1, 2022. (Accessed Jun. 2023).
ELIGIBLE SERVICES/SPECIALTIES
The department shall pay for all services covered by the medical assistance program provided through telehealth if the department pays for those services when provided in person, including:
- behavioral health services;
- services covered under home and community-based waivers;
- services covered under state plan options under 42 U.S.C. 1396-1396p (Title XIX, Social Security Act);
- services provided by a community health aide or a community health practitioner certified by the Community Health Aide Program Certification Board;
- services provided by a behavioral health aide or behavioral health practitioner certified by the Community Health Aide Program Certification Board;
- services provided by a dental health aide therapist certified by the Community Health Aide Program Certification Board;
- services provided by a chemical dependency counselor certified by a certifying entity for behavioral health professionals in the state specified by the department in regulation;
- services provided by a rural health clinic or a federally qualified health center;
- services provided by an individual or entity that is required by statute or regulation to be licensed or certified by the department or that is eligible to receive payments, in whole or in part, from the department;
- services provided through audio, visual, or data communications, alone or in any combination, or through communications over the Internet or by telephone, including a telephone that is not part of a dedicated audio conference system, electronic mail, text message, or two-way radio;
- assessment, evaluation, consultation, planning, diagnosis, treatment, case management, and the prescription, dispensing, and administration of medications, including controlled substances; and
- services covered under federal waivers or demonstrations other than home and community-based waivers.
The department shall adopt regulations for services provided by telehealth, including setting rates of payment. The department may set a rate of payment for a services provided through telehealth that is different from the rate of payment for the same service provided in person. The department may exclude or limit coverage or reimbursement for a service provided by telehealth, or limit the telehealth modes that may be used for a particular service, only if the department
- specifically excludes or limits the service from telehealth coverage or reimbursement by regulations adopted under this subsection;
- determines, based on substantial medical evidence, that the service cannot be safely provided using telehealth or using the specified mode; or
- determines that providing the service using the specified mode would violate federal law or render the service ineligible for federal financial participation under applicable federal law.
All services delivered through telehealth under this section must comply with the Health Insurance Portability and Accountability Act of 1996 (P.L. 104-191).
SOURCE: AK Statute Sec. 47.07.069, (Accessed Jun. 2023).
Medically necessary office consultations provided via telemedicine may be covered only when used as a second opinion and the provider is of a different specialty than the requesting provider. Documentation requirements apply.
SOURCE: Alaska Medicaid Policy Clarification: Office Consultations via Telemedicine Applications. March 30, 2017 & Alaska Medicaid Policy Clarification; Medicaid Telehealth Coverage. Mar. 1, 2022. (Accessed Jun. 2023).
Eligible services:
- Initial or one follow-up office visit;
- Consultation made to confirm diagnosis;
- A diagnostic, therapeutic or interpretive service;
- Psychiatric or substance abuse assessments;
- Psychotherapy; or
- Pharmacological management services on an individual recipient basis.
SOURCE: State of AK Dept. of Health and Social Svcs., Alaska Medical Assistance Provider Billing Manuals for Community Behavioral Health Services; Mental Health Physician Clinic (1/2/2019); & Physician, ARNP, PA Services (5/13) & Alaska Medicaid Policy Clarification: Medicaid Telehealth Coverage. Mar. 1, 2022 (Accessed Jun. 2023).
Family psychotherapy may be provided through telemedicine, with or without recipient involvement, if the services could not be provided in person and the clinician documents the reason for providing the service telephonically in the recipient’s treatment notes for each session.
SOURCE: AK Dept. of Health and Social Svcs. Billing for Telemedicine Services. Community Behavioral Health Clinic Services; Mental Health Physician Clinic (1/2/19). (Accessed Jun. 2023).
The GT or 95 modifier should be used to indicate live interactive mode. Use place of service 10 if member is in their home during the telehealth visit and 02 if member is at any other location.
SOURCE: Alaska Medicaid Policy Clarification: Medicaid Telehealth Coverage. Mar. 1, 2022. (Accessed Jun. 2023).
Dental services do not require the use of the telemedicine modifier.
SOURCE: AK Dept. of Health and Social Svcs. Dental Services. Tribal Services Manual (1/3/17). (Accessed Jun. 2023).
The department will pay only for professional services for a telemedicine application of service. The department will not pay for the use of technological equipment and systems associated with a telemedicine application to render the service.
SOURCE: AK Admin. Code, Title 7, 110.635 (Accessed Jun. 2023).
Alaska Medicaid will not pay for
- The use of telemedicine equipment and systems
- Services delivered by telephone when not part of a dedicated audio conference system
- Services delivered by fax
SOURCE: State of AK Dept. of Health and Social Svcs., Alaska Medical Assistance Provider Billing Manuals for Community Behavioral Health Services; Mental Health Physician Clinic (1/2/2019); Physician, ARNP and PA Services (5/13) (Jun. 2023).
No reimbursement for:
- Direct entry midwife
- Durable medical equipment (DME)
- End-stage renal disease
- Home and community-based waiver
- Personal care assistant
- Pharmacy
- Private duty nursing
- Transportation and accommodation
- Vision (includes visual care, dispensing, or optician services)
SOURCE: State of AK Dept. of Health and Social Svcs., Alaska Medical Assistance Provider Billing Manuals for Community Behavioral Health Services; Mental Health Physician Clinic (1/2/2019); Physician, ARNP and PA Services (5/13), & AK Admin. Code, Title 7, 110.635 & Alaska Medicaid Policy Clarification: Medicaid Telehealth Coverage. Mar. 1, 2022. (Accessed Jun. 2023).
The department will pay for a service rendered by a consulting or referring provider by a telemedicine application. Payment to the presenting provider is limited to the rate established for brief evaluation and management of an established patient. The department will pay the receiving provider in the same manner as payment is made for the same service provided through traditional mode of delivery, not to exceed 100 percent of the rate established under 7 AAC 145.050.
SOURCE: AK Admin Code, Title 7, 145.270, (Accessed Jun. 2023).
The department will not pay a physician for experimental therapy, nonmedical outpatient therapy, or nonmedical counseling, including any of the following services:
- interaction between recipient and provider by means of the Internet, except as provided in 7 AAC 110.620 — 7 AAC 110.639 for telemedicine services.
SOURCE: Alaska Admin Code, Title 7, 110.445, (Accessed Jun. 2023).
ELIGIBLE PROVIDERS
The department shall pay for all services covered by the medical assistance program provided through telehealth if the department pays for those services when provided in person, including:
…
- services provided by a community health aide or a community health practitioner certified by the Community Health Aide Program Certification Board;
- services provided by a behavioral health aide or behavioral health practitioner certified by the Community Health Aide Program Certification Board;
- services provided by a dental health aide therapist certified by the Community Health Aide Program Certification Board;
- services provided by a chemical dependency counselor certified by a certifying entity for behavioral health professionals in the state specified by the department in regulation;
- services provided by a rural health clinic or a federally qualified health center;
- services provided by an individual or entity that is required by statute or regulation to be licensed or certified by the department or that is eligible to receive payments, in whole or in part, from the department;
SOURCE: AK Statute Sec. 47.07.069, (Accessed Jun. 2023).
Providers fall into three categories:
- Referring Provider: Evaluates a patient, determines the need for a consultation, and arranges services of a consulting provider for the purpose of diagnosis and treatment.
- Presenting Provider: Introduces a patient to the consulting provider during an interactive telemedicine session (may assist in the telemedicine consultation).
- Consulting Provider: Evaluates the patient and/or medical data/images using telemedicine mode of delivery upon recommendation of the referring provider.
SOURCE: AK Dept. of Health and Social Svcs. Billing for Telemedicine Services. Audiology Services (6/12); Autism Services (6/12); Chiropractic Services (6/12); Community Behavioral Health Clinic Services (6/12); Direct-Entry Midwives Services (6/12); EPSDT (6/12); Family Planning (6/12); FQHC/RHC (6/12); Imaging Services (6/12); Independent Laboratory (6/12); Mental Health Physician Clinic (6/12); Nutrition (6/12); Physician (6/12); Private Duty Nursing (6/12); Psychologist (6/12); Podiatry (6/12); School-Based Services (6/12); Residential Behavioral Rehabilitation Services (6/12); Therapies (6/12); Vision (6/12) & Alaska Admin Code Title 7, Sec. 110.639. (Accessed Jun. 2023).
Office consultations performed by a provider of the same specialty within the same organization are not covered.
SOURCE: Alaska Medicaid Policy Clarification: Office Consultations via Telemedicine Applications. March 30, 2017. (Accessed Jun. 2023).
Mental Health
An entity designated by the department under AS 47.30.520 – 47.30.620 may provide community mental health services authorized under AS 47.30.520 – 47.30.620 through telehealth to a patient in this state.
If an individual employed by an entity designated by the department under AS 47.30.520 – 47.30.620, in the course of a telehealth encounter with a patient, determines that some or all of the encounter will extend beyond the community mental health services authorized under AS 47.30.520 – 47.30.620, the individual shall advise the patient that the entity is not authorized to provide some or all of the services to the patient, recommend that the patient contact an appropriate provider for the services the entity is not authorized to provide, and limit the encounter to only those services the entity is authorized to provide. The entity may not charge a patient for any portion of an encounter that extends beyond the community mental health services authorized under AS 47.30.520 – 47.30.620.
A fee for a service provided through telehealth under this section must be reasonable and consistent with the ordinary fee typically charged for that service and may not exceed the fee typically charged for that service.
An entity permitted to provide telehealth under this section may not be required to document a barrier to an in-person visit to provide health care services through telehealth. The department may not limit the physical setting from which an entity may provide health care services through telehealth.
Nothing in this section requires the use of telehealth when an individual employed by an entity designated by the department under AS 47.30.520 – 47.30.620 determines that providing services through telehealth is not appropriate or when a patient chooses not to receive services through telehealth.
SOURCE: AK Statute Sec. 47.30.585, (Accessed Jun. 2023).
Uniform Alcoholism and Intoxication Treatment
A public or private treatment facility approved under AS 47.37.140 may provide health care services authorized under AS 47.37.030 – 47.37.270 through telehealth to a patient in this state.
If an individual employed by a public or private treatment facility approved under AS 47.37.140, in the course of a telehealth encounter with a patient, determines that some or all of the encounter will extend beyond the health care services authorized under AS 47.37.030 – 47.37.270, the individual shall advise the patient that the facility is not authorized to provide some or all of the services to the patient, recommend that the patient contact an appropriate provider for the services the facility is not authorized to provide, and limit the encounter to only those services the facility is authorized to provide. The facility may not charge a patient for any portion of an encounter that extends beyond the health care services authorized under AS 47.37.030 – 47.37.270.
A fee for a service provided through telehealth under this section must be reasonable and consistent with the ordinary fee typically charged for that service and may not exceed the fee typically charged for that service.
A facility permitted to practice telehealth under this section may not be required to document a barrier to an in-person visit to provide health care services through telehealth. The department may not limit the physical setting from which a facility may provide health care services through telehealth.
Nothing in this section requires the use of telehealth when an individual employed by a facility approved under AS 47.37.140 determines that providing services through telehealth is not appropriate or when a patient chooses not to receive services through telehealth.
SOURCE: AK Statute Sec. 47.37.145, (Accessed Jun. 2023).
ELIGIBLE SITES
The GT or 95 modifier should be used to indicate live interactive mode. Use place of service 10 if member is in their home during the telehealth visit and 02 if member is at any other location.
SOURCE: Alaska Medicaid Policy Clarification: Medicaid Telehealth Coverage. Mar. 1, 2022. (Accessed Jun. 2023).
GEOGRAPHIC LIMITS
No reference found.
FACILITY TRANSMISSION FEE
The department will pay only for professional services for a telemedicine application of service. The department will not pay for the use of technological equipment and systems associated with a telemedicine application to render the service.
SOURCE: AK Admin. Code, Title 7, 110.635(b). (Accessed Jun. 2023).
Last updated 06/21/2023
Miscellaneous
Documentation requirements for telemedicine consultations include:
- Statement that the service was provided using telemedicine
- The address location of the patient
- The address location of the provider
- The method of telemedicine used
- The names of all persons participating in the telemedicine service and their role in the encounter
- The inquiry from the requesting provider
- The consulting provider’s report back to the requesting provider (see policy for more details).
SOURCE: Alaska Medicaid Policy Clarification: Office Consultations via Telemedicine Applications. March 30, 2017. (Accessed Jun. 2023).
Payment to the presenting provider is limited to the rate established for brief evaluation and management of an established patient.
Receiving providers will be reimbursed in the same manner as reimbursement is made for the same service provided through traditional modes of delivery, not to exceed 100 percent of the rate established in state law.
SOURCE: AK Admin Code, Title 7, 145.270. (Accessed Jun. 2023).
Family psychotherapy may be provided through telemedicine, with or without recipient involvement, if the services could not be provided in person and the clinician documents the reason for providing the service telephonically in the recipient’s treatment notes for each session.
SOURCE: Mental Health Physician Clinic, Psychotherapy (1/2/19) (Accessed Jun. 2023).
Medical Assistance Reform Program
The department shall identify the areas of the state where improvements in access to telehealth would be most effective in reducing the costs of medical assistance and improving access to health care services for medical assistance recipients. The department shall make efforts to improve access to telehealth for recipients in those locations. The department may enter into agreements with Indian Health Service providers, if necessary, to improve access by medical assistance recipients to telehealth facilities and equipment.
SOURCE: Alaska Statute 47.05.270, (Accessed Jun. 2023).
Last updated 06/21/2023
Store and Forward
POLICY
The department shall pay for all services covered by the medical assistance program provided through telehealth if the department pays for those services when provided in person, including …
- services provided through audio, visual, or data communications, alone or in any combination, or through communications over the Internet or by telephone, including a telephone that is not part of a dedicated audio conference system, electronic mail, text message, or two-way radio.
SOURCE: AK Statute Sec. 47.07.069, (Accessed Jun. 2023).
Alaska Medicaid will reimburse for Store & Forward telehealth, which is defined as the “provider sends digital images, sounds, or previously recorded video to a consulting provider at a different location. The consulting provider reviews the information and reports back his or her analysis.
SOURCE: State of AK Dept. of Health and Social Svcs., Alaska Medical Assistance Provider Billing Manuals for Community Behavioral Health Services (1/2/19); Mental Health Physician Clinic (1/2/2019); Physician, ARNP and PA Services (5/13), (Accessed Jun. 2023).
The department will pay for medical services furnished through telemedicine applications as an alternative to traditional methods of delivering services to Medicaid recipients. For the provider to receive payment, the provider’s use of telemedicine applications must comply with the standards for services delivered under the Medicaid program and for the medical services provided by the type of provider, including provisions that affect the efficiency, economy and quality of service; and coverage limitations. Store-and-forward services must be provided through the transference of digital images, sounds, or previously recorded video from one location to another to allow a consulting provider to obtain information, analyze it, and report back to the referring provider.
SOURCE: Alaska Admin Code. Title 7, Sec. 110.620 & 625. (Accessed Jun. 2023).
ELIGIBLE SERVICES/SPECIALTIES
A consulting provider may send data he/she has received during a store-and-forward telemedicine consultation to another consulting provider (with equal or greater scope of practice as determined by his/her occupational license or level of expertise within their field of specialty).
SOURCE: AK Dept. of Health and Social Svcs. Billing for Telemedicine Services. Audiology Services (6/12); Autism Services (6/12); Chiropractic Services (6/12); Community Behavioral Health Clinic Services (6/12); Direct-Entry Midwives Services (6/12); EPSDT (6/12); Family Planning (6/12); FQHC/RHC (6/12); Imaging Services (6/12); Independent Laboratory (6/12); Mental Health Physician Clinic (6/12); Nutrition (6/12); Physician (6/12); Private Duty Nursing (6/12); Professional Claims Management (6/12): Psychologist (6/12); Podiatry (6/12); School-Based Services (6/12); Residential Behavioral Rehabilitation Services (6/12); Therapies (6/12); Vision (6/12) (Accessed Jun. 2023).
Eligible services:
- Initial or one follow-up office visit;
- Consultation made to confirm diagnosis;
- A diagnostic, therapeutic or interpretive service;
- Psychiatric or substance abuse assessments;
- Psychotherapy; or
- Pharmacological management services on an individual recipient basis.
SOURCE: State of AK Dept. of Health and Social Svcs., Alaska Medical Assistance Provider Billing Manuals for Community Behavioral Health Services; Mental Health Physician Clinic (1/2/2019); & Physician, ARNP and PA Services (5/13) & Alaska Medicaid Policy Clarification: Medicaid Telehealth Coverage. Mar. 1, 2022. (Accessed Jun. 2023).
GEOGRAPHIC LIMITS
No Reference Found
TRANSMISSION FEE
The department will pay only for professional services for a telemedicine application of service. The department will not pay for the use of technological equipment and systems associated with a telemedicine application to render the service.
SOURCE: AK Admin. Code, Title 7, 110.635(b). (Accessed Jun. 2023).