Arizona

Disclaimer

PLEASE NOTE: CCHP is providing the following for informational purposes only. We are not providing legal advice or interpretation of the laws and regulations and policies. CCHP encourages you to check with the appropriate state agency for further information and direction. This information should not be construed as legal counsel. Consult with an attorney if you are seeking a legal opinion.

At A Glance
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MEDICAID REIMBURSEMENT

  • Live Video: Yes
  • Store-and-Forward: Yes
  • Remote Patient Monitoring: Yes
  • Audio Only: Yes

PRIVATE PAYER LAW

  • Law Exists: Yes
  • Payment Parity: Yes

PROFESSIONAL REQUIREMENTS

  • Licensure Compacts: IMLC, NLC, OT, PSY, PTC
  • Consent Requirements: Yes

FQHCs

  • Originating sites explicitly allowed for Live Video: No
  • Distant sites explicitly allowed for Live Video: Yes
  • Store and forward explicitly reimbursed: No
  • Audio-only explicitly reimbursed: No
  • Allowed to collect PPS rate for telehealth: No

STATE RESOURCES

  1. Medicaid Program: Arizona Health Care Cost Containment System (AHCCCS)
  2. Administrator: Arizona Health Care Cost Containment System Administration
  3. Regional Telehealth Resource Center: Southwest Telehealth Resource Center
Disclaimer

PLEASE NOTE: CCHP is providing the following for informational purposes only. We are not providing legal advice or interpretation of the laws and regulations and policies. CCHP encourages you to check with the appropriate state agency for further information and direction. This information should not be construed as legal counsel. Consult with an attorney if you are seeking a legal opinion.

COVID-19

Last updated 01/03/2023

Audio Only Delivery

Medicaid:  Telehealth Delivery and Billing FAQs

STATUS: Active

Last updated 01/03/2023

Cross State Licensing

Previous COVID-19 waivers expired.

Last updated 01/03/2023

Easing Consent Requirements

Medicaid:  Telehealth Delivery and Billing FAQs

STATUS: Active

Last updated 01/03/2023

Easing Prescribing Requirements

Medicaid:  Telehealth Delivery and Billing FAQs

STATUS: Active

Last updated 01/03/2023

Miscellaneous

Office of the Governor: Executive Order (EO) on Rescinding Telemedicine EOs (2021-13) due to Passage of Permanent Legislation

Status: Permanent

Last updated 01/03/2023

Originating Site

No Reference Found

Last updated 01/03/2023

Private Payer

Previous COVID-19 waivers expired.

Last updated 01/03/2023

Provider Type

Medicaid:  Telehealth Delivery and Billing FAQs

STATUS: Active

Last updated 01/03/2023

Service Expansion

Medicaid:  Telehealth Delivery and Billing FAQs

STATUS: Active

Private Payer

Last updated 01/03/2023

Definitions

[Telehealth] means the interactive use of audio, video or other electronic media, including asynchronous store-and-forward technologies and remote patient monitoring technologies, for the purpose of diagnosis, consultation or treatment.  Includes:

  • The use of an audio-only telephone encounter between a subscriber who has an existing relationship with a health care provider or provider group if both of the following apply:
    • An audio-visual telehealth encounter is not reasonably available due to the subscriber’s functional status, the subscriber’s lack of technology or telecommunications infrastructure limits, as determined by the health care provider.
    • The telehealth encounter is initiated at the request of the subscriber or authorized by the subscriber before the telehealth encounter.
  • The use of an audio-only encounter between the subscriber and a health care provider, regardless of whether there is an existing relationship with the health care provider or provider group, if the telehealth encounter is for a behavioral health or substance use disorder service and both items of subdivision (a) of this paragraph apply.

Does not include the sole use of a fax machine, instant messages, voice mail or email.

SOURCE:  AZ Rev. Statutes. Sec. 20-841.09 & 20-1057.13 & 20-1376.05 & 20-1406.05  (Accessed Jul. 2022).

Under Arizona Administrative Code, Department of Insurance, Health Care Services Organizations Oversight, “telemedicine means diagnostic, consultation, and treatment services that occur in the physical presence of an enrollee on a real-time basis through interactive audio, video, or data communication.”

SOURCE: AZ Admin. Code Sec. R20-6-1902. Pg. 154 (Accessed Jan. 2023).

Last updated 10/19/2022

Parity

SERVICE PARITY

All contracts issued, delivered or renewed in this state must provide coverage for health care services that are provided through telehealth if the health care service would be covered were it provided through an in-person encounter between the subscriber and a health care provider and provided to a subscriber receiving the service in this state.

A corporation may not limit or deny the coverage of health care services provided through telehealth, including ancillary services, and may apply only the same limits or exclusions on a health care service provided through telehealth that are applicable to an in-person encounter for the same health care service, except for procedures or services for which the weight of evidence, based on practice guidelines, peer-reviewed clinical publications or research or recommendations by the telehealth advisory committee on telehealth best practices established by section 36-3607, determines not to be appropriate to be provided through telehealth.

Beginning January 1, 2022, a corporation shall cover services provided through an audio-only telehealth encounter if the telehealth advisory committee on telehealth best practices established by section 36-3607 recommends that the services may appropriately be provided through an audio-only telehealth encounter.

Certain other requirements apply.  See above ‘requirements’ section.

SOURCE:  AZ Rev. Statutes. Sec. 20-841.09 & 20-1057.13 & 20-1376.05 & 20-1406.05  (Accessed Jan. 2023).

PAYMENT PARITY

A corporation shall reimburse health care providers at the same level of payment for equivalent services as identified by the healthcare common procedure coding system, whether provided through telehealth using an audio-visual format or in-person care. A corporation shall reimburse health care providers at the same level of payment for equivalent in-person behavioral health and substance use disorder services as identified by the healthcare common procedure coding system if provided through telehealth using an audio-only format. This paragraph does not apply to a telehealth encounter provided through a telehealth platform that is sponsored or provided by the corporation. A corporation may not require a health care provider to use a telehealth platform that is sponsored or provided by the corporation as a condition of network participation.

A health care provider shall bill for a telehealth encounter using the healthcare common procedure coding system and shall identify whether the telehealth encounter was provided in an audio-only or audio-video format. To submit a claim for an audio-only service, the health care provider must make telehealth services generally available to patients through the interactive use of audio, video or other electronic media.

SOURCE:  AZ Rev. Statutes. Sec. 20-841.09 & 20-1057.13 & 20-1376.05 & 20-1406.05  (Accessed Jan. 2023).

Last updated 01/03/2023

Requirements

All contracts issued, delivered or renewed in this state must provide coverage for health care services that are provided through telehealth if the health care service would be covered were it provided through an in-person encounter between the subscriber and a health care provider and provided to a subscriber receiving the service in this state. The following requirements apply to coverage of telehealth services:

  • A corporation may not limit or deny the coverage of health care services provided through telehealth, including ancillary services, and may apply only the same limits or exclusions on a health care service provided through telehealth that are applicable to an in-person encounter for the same health care service, except for procedures or services for which the weight of evidence, based on practice guidelines, peer-reviewed clinical publications or research or recommendations by the telehealth advisory committee on telehealth best practices established by section 36-3607, determines not to be appropriate to be provided through telehealth.
  • Except as otherwise provided in this paragraph, a corporation shall reimburse health care providers at the same level of payment for equivalent services as identified by the healthcare common procedure coding system, whether provided through telehealth using an audio-visual format or in-person care. A corporation shall reimburse health care providers at the same level of payment for equivalent in-person behavioral health and substance use disorder services as identified by the healthcare common procedure coding system if provided through telehealth using an audio-only format. This paragraph does not apply to a telehealth encounter provided through a telehealth platform that is sponsored or provided by the corporation. A corporation may not require a health care provider to use a telehealth platform that is sponsored or provided by the corporation as a condition of network participation.
  • Before January 1, 2022, a corporation shall cover services provided through an audio-only telehealth encounter if that service is covered by medicare or the Arizona health care cost containment system when provided through an audio-only telehealth encounter. Beginning January 1, 2022, a corporation shall cover services provided through an audio-only telehealth encounter if the telehealth advisory committee on telehealth best practices established by section 36-3607 recommends that the services may appropriately be provided through an audio-only telehealth encounter.
  • A health care provider shall bill for a telehealth encounter using the healthcare common procedure coding system and shall identify whether the telehealth encounter was provided in an audio-only or audio-video format. To submit a claim for an audio-only service, the health care provider must make telehealth services generally available to patients through the interactive use of audio, video or other electronic media.
  • At the time of the telehealth encounter, the health care provider shall access clinical information and records, if available, that are appropriate to evaluate the patient’s condition. The health care provider shall inform the subscriber before the telehealth encounter if there is a charge for the encounter.
  • A corporation may establish reasonable requirements and parameters for telehealth services, including documentation, fraud prevention, identity verification and recordkeeping, but such requirements and parameters may not be more restrictive or less favorable to health care providers or subscribers than are required for health care services delivered in person.
  • Covered telehealth services may be provided regardless of where the subscriber is located or the type of site.
  • Except in an emergency, the contract may limit the coverage to those health care providers who are members of the corporation’s provider network.

This section does not relieve a corporation from an obligation to provide adequate access to in-person health care services. Network adequacy standards required by federal or state law may not be met by a corporation through the use of contracted health care providers who provide only telehealth services and do not provide in-person health care services in this state or within fifty miles of the border of this state.

Services provided through telehealth or resulting from a telehealth encounter are subject to all of this state’s laws and rules that govern prescribing, dispensing and administering prescription pharmaceuticals and devices and shall comply with Arizona licensure requirements and any practice guidelines of the telehealth advisory committee on telehealth best practices established by section 36-3607 or, if not addressed, the practice guidelines of a national association of medical professionals promoting access to medical care for consumers via telecommunications technology or other qualified medical professional societies to ensure quality of care.

SOURCE:  AZ Rev. Statutes. Sec. 20-841.09 & 20-1057.13 & 20-1376.05 & 20-1406.05  (Accessed Jan. 2023).

Health Care Service Organizations (HCSO) are allowed, but not mandated, to provide access to covered services through:

  • Telephone calls and messages
  • Electronic mail
  • Communication with the physician’s or practitioner’s staff,
  • Coverage by another physician or practitioner, or
  • Telemedicine,

SOURCE: AZ Admin. Code Sec. R20-6-1915. Pg. 157 (Accessed Jan. 2023).

Medicaid

Last updated 01/03/2023

Consent Requirements

Informed consent standards for Telehealth services shall adhere to all applicable statutes and policies governing informed consent, including A.R.S. § 36-3602.

SOURCE: AZ Health Care Cost Containment System. Telehealth and Telemedicine Ch 300, (320-I pg. 4), Approved Apr. 2022. (Accessed Jan. 2023).

Before a provider delivers health care via telehealth, informed consent, written or verbal, is required to be obtained from a member or the member’s Health Care Decision Maker. Exceptions to this consent requirement include:

  • If the telehealth interaction does not take place in the physical presence of the member,
  • In an emergency situation in which the member, or when applicable, the member’s Health Care Decision Maker is unable to give Informed Consent, or
  • Transmission of diagnostic images to a health care provider serving as a consultant or the reporting of diagnostic test results by that consultant.

SOURCE: AZ Health Care Cost Containment System. AHCCCS General and Informed Consent, Ch. 320-Q. pg. 4. 07/01/20. (Accessed Jan. 2023).

Last updated 01/03/2023

Definition

Telehealth:  Healthcare services delivered via asynchronous , audio-only, remote patient monitoring, teledentistry, or telemedicine.

Telemedicine: The practice of synchronous (real-time) health care delivery, diagnosis, consultation, and treatment and the transfer of medical data through interactive audio and video communications that occur in the physical presence of the member.

SOURCE: AZ Health Cost Containment System, AHCCCS Contract and Policy Dictionary, 10/22, pg. 106, (Accessed Jan. 2023).

Telehealth means services delivered via:

  • Asynchronous (store and forward);
  • Remote patient monitoring;
  • Teledentistry; or
  • Telemedicine (real-time interactive audio-video)

Teledentistry is “the acquisition and transmission of all necessary subjective and objective diagnostic data through interactive audio, video or data communications by an AHCCCS registered dental provider to a dentist at a distant site for triage, dental treatment planning, and referral.”

Telemedicine is “the practice of synchronous (real-time) health care delivery, diagnosis, consultation and treatment and the transfer of medical data through interactive audio, video or data communications that occur in the physical presence of the patient.

SOURCE: AZ Health Care Cost Containment System, AHCCCS Fee-For-Service Provider Billing Manual, Ch. 10: Individual Practitioner Services, (8/23/22), pg. 49, & IHS/Tribal Provider Billing Manual, (10/17/2022), pg. 51. (Accessed Jan. 2023).

Telemedicine services include health care delivery, diagnosis, consultation, treatment, and the transfer of medical data through real-time synchronous interactive audio and video communications that occur in the physical presence of the member.

SOURCE: AZ Health Care Cost Containment System, AHCCCS Medical Policy for AHCCCS Covered Services, Ch. 300, (320-I pg. 2). Approved Apr. 2022. (Accessed Jan. 2023).

Telehealth is the use of digital technology, like computers, telephones, smartphones, and tablets, to access health care services remotely.

SOURCE: AZ Health Care Cost Containment System. Telehealth Services, (Accessed Jan. 2023).

Last updated 01/03/2023

Email, Phone & Fax

Telehealth – Audio Only:  The practice of synchronous (real-time) health care delivery, through interactive audio-only communications.

SOURCE: AZ Health Cost Containment System, AHCCCS Contract and Policy Dictionary, 10/22, pg. 107, (Accessed Jan. 2023).

AHCCCS covers audio-only services if a Telemedicine encounter is not reasonably available due to the member’s functional status, the member’s lack of technology or telecommunications infrastructure limits, as determined by the provider. To submit a claim for an audio-only service, the provider must make the telehealth services generally available to members through Telemedicine.

The Contractor and AHCCCS shall reimburse providers at the same level of payment for equivalent in-person mental health and substance use disorder services, as identified by HCPCS, if provided through Telehealth using an audio-only format. The AHCCCS Telehealth code set defines which codes are billable as an audio-only service and the applicable modifier(s) and place of service providers must use when billing for an audio-only
service.

SOURCE: AZ Health Care Cost Containment System, AHCCCS Medical Policy for AHCCCS Covered Services, Ch. 300, (320-I pg. 3). Approved Apr. 2022. (Accessed Jan. 2023).

AHCCCS covers all major forms of telehealth services. Asynchronous (also called “store and forward”) occurs when services are not delivered in real-time, but are uploaded by providers and retrieved, perhaps to an online portal. Telephonic services (audio-only) use a traditional telephone to conduct health care appointments. Telemedicine involves interactive audio and video, in a real-time, synchronous conversation. AHCCCS also covers telehealth for remote patient monitoring and teledentistry.

A list of reimbursable codes for permanent telephonic delivery is linked on the AHCCCS Telehealth Services webpage.

SOURCE: AZ Health Care Cost Containment System. Telehealth Services, (Accessed Jan. 2023).

Two HCPCS codes are included in this section of the 2021/2022 Fee Schedule:

  • G2010 – Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment.
  • G2012 – Brief communication technology-based service, e.g., virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion.

SOURCE: AZ Administrative Code Title 20, Ch. 5, pg. 346. (Accessed Jan. 2023).

HCPCS code H0030 (Behavioral Health Hotline Service) shall replace T1016 as the dedicated crisis telephone billing code. The applicable rates and modifiers for crisis telephone billing that were valid for T1016 will now be valid for H0030. This includes modifiers HO (Master’s Degree level), HN (Bachelor’s Degree level) and ET (Emergency Services). Note: Providers rendering telephonic crisis services to Tribal ALTCS members shall also bill for these services with H0030. When billing more than (1) unit of H0030 per day, all units should be included on the same line. Reporting units on more than one line may cause the claim to deny as a duplicate.

SOURCE: Fee-for-Service Provider Billing Manual Behavioral Health Services, Ch. 19, p. 11 (Revised 10/1/21), (Accessed Jan. 2023).

Last updated 01/03/2023

Live Video

POLICY

Fee-for-Service Provider Manual

AHCCCS covers medically necessary, non-experimental and cost-effective services provided via telehealth. There are no geographic restrictions for telehealth; services delivered via telehealth are covered by AHCCCS in rural and metropolitan regions.

Telehealth may include healthcare services delivered via asynchronous (store and forward), remote patient monitoring, teledentistry, or telemedicine (interactive audio and video).

SOURCE: AZ Health Care Cost Containment System, AHCCCS Fee-For-Service Provider Billing Manual, Ch. 10: Individual Practitioner Services, (8/23/2022), pg. 51, & IHS/Tribal Provider Billing Manual, (10/17/2022), pg. 50 (Accessed Jan. 2023).

The Contractor and FFS programs shall cover medically necessary, non-experimental, and cost effective services delivered via Telehealth by AHCCCS registered providers for AHCCCS covered services.

SOURCE: AZ Health Care Cost Containment System, AHCCCS Medical Policy for AHCCCS Covered Services, Ch. 300, (320-I pg. 1). Approved Apr. 2022. (Accessed Jan. 2023).

ELIGIBLE SERVICES/SPECIALTIES

Some of the services that can be covered via real-time telehealth include, but are not limited to:

  • Behavioral Health
  • Cardiology
  • Dentistry
  • Dermatology
  • Endocrinology
  • Hematology/Oncology
  • Home Health
  • Infectious Diseases
  • Inpatient Consultations
  • Medical Nutrition Therapy (MNT)
  • Neurology
  • Obstetrics/Gynecology
  • Oncology/Radiation
  • Ophthalmology
  • Orthopedics
  • Office Visits (adult and pediatric)
  • Outpatient Consultations
  • Pain Clinic
  • Pathology & Radiology
  • Pediatrics and Pediatric Subspecialties
  • Pharmacy Management
  • Rheumatology
  • Surgery Follow-Up and Consultations

Behavioral health services are covered for all Medicaid-eligible AHCCCS beneficiaries and KidsCare members.

Covered behavioral health services can include, but are not limited to:

  • Diagnostic consultation and evaluation,
  • Psychotropic medication adjustment and monitoring,
  • Individual and family counseling, and
  • Case management.

For a complete code set of services, along with their eligible place of service and modifiers, that can be billed as telehealth please visit the AHCCCS Medical Coding Resources webpage.

SOURCE: AZ Health Care Cost Containment System, AHCCCS Fee-For-Service Provider Billing Manual, Ch. 10: Individual Practitioner Services, (8/23/2022), pg. 51-53; IHS/Tribal Provider Billing Manual, Ch. 8 Individual Practitioner Services, (10/17/2022), pg. 50-52 (Accessed Jan. 2023).

Prolonged preventive services, beyond the typical service of the primary procedure, that require direct patient contact and occur in either the office or another outpatient setting are covered under telehealth. See manual for example codes.

SOURCE: AZ Health Care Cost Containment System, AHCCCS Fee-For-Service Provider Manual, Ch. 10: Individual Practitioner Services, (8/23/2022), pg. 50, (Accessed Jan. 2023).

AHCCCS Policy Manual

The Contractor and FFS programs may not limit or deny the coverage of services provided through Telehealth and may apply only the same limits or exclusions on a service provided through Telehealth that are applicable to an in-person encounter for the same service, except for services for which the weight of evidence, based on practice guidelines, peer-reviewed clinical publications or research or recommendations by the Telehealth advisory committee on Telehealth best practices established by A.R.S. § 36-3607, determines not to be appropriate to be provided through Telehealth.

Services delivered via Telehealth shall not replace member or provider choice for healthcare delivery modality. As specified in A.R.S. § 36-3605i , a provider shall make a good faith effort in determining both of the following:

  • Whether a service should be provided through Telehealth instead of in-person. The provider shall use clinical judgment in considering whether the nature of the services necessitates physical interventions and close observation and the circumstances of the member, including diagnosis, symptoms, history, age, physical location and access to telehealth; and
  • The communication medium of Telehealth and, whenever reasonably practicable, the telehealth communication medium that allows the provider to most effectively assess, diagnose and treat the member. Factors the provider may consider in determining the communication medium include the member’s lack of access to or inability to use technology or limits in telecommunication infrastructure necessary to support interactive Telehealth encounters.

The Contractor and FFS Programs shall reimburse providers at the same level of payment for equivalent services as identified by Healthcare Common Procedure Coding System (HCPCS) whether provided via Telemedicine or in-person.

The AHCCCS Telehealth code set defines which codes are billable as a Telemedicine service and the applicable modifier(s) and place of service providers must use when billing for a service provided via Telemedicine.

Refer to the AHCCCS coding webpage for coding requirements for Telehealth services, including applicable modifiers and POS available:
https://www.azahcccs.gov/PlansProviders/MedicalCodingResources.html

AHCCCS covers Teledentistry for Early and Periodic Screening, Diagnostic and Treatment (EPSDT) aged members when provided by an AHCCCS registered dental provider. Refer to AMPM Policy 431 for more information on oral health care for EPSDT aged members including covered dental
services.

Teledentistry includes the provision of preventative and other approved therapeutic services by the AHCCCS registered Affiliated Practice Dental Hygienist, who provides dental hygiene services under an affiliated practice relationship with a dentist. Refer to AMPM Policy 431 for information on Affiliated Practice Dental Hygienist.

Teledentistry does not replace the dental examination by the dentist. Limited exams may be billed through the use of Teledentistry. Periodic and comprehensive examinations cannot be billed through the use of teledentistry alone.

SOURCE: AZ Medical Policy for AHCCCS Covered Services. Telehealth and Telemedicine Ch 300, (320-I pg. 1-2 & 4-5), Approved Apr. 2022. (Accessed Jan. 2023)

Arizona health care cost containment system administration shall implement teledentistry services for enrolled members who are under twenty-one years of age.

SOURCE: AZ Statute, Sec. 36-2907.13. (Accessed Oct. 2022).

Two HCPCS codes are included in this section of the 2021/2022 Fee Schedule:

  • G2010 – Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment.
  • G2012 – Brief communication technology-based service, e.g., virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion.

SOURCE: AZ Administrative Code Title 20, Ch. 5, pg. 346. (Accessed Jan. 2023).

ELIGIBLE PROVIDERS

Fee-for-Service Provider Manual & IHS/Tribal Provider Billing Manual

Telehealth, including Teledentistry services, may be provided by AHCCCS registered providers, within their scope of practice.

SOURCE: AZ Health Care Cost Containment System, AHCCCS Fee-For- Service Provider Billing Manual, Ch. 10: Individual Practitioner Services, (8/23/2022), pg. 50,  & IHS/Tribal Provider Billing Manual (10/17/2022), pg. 53. (Accessed Jan. 2023).

Telehealth and telemedicine may qualify as a FQHC/RHC visit if it meets the requirements as specified in AMPM Policy 320-I.

SOURCE: AZ Health Care Cost Containment System, AHCCCS. Provider Qualifications and Provider Requirements.  Ch. 600, Oct. 2015, pg. 3, & AZ Health Care Cost Containment System, AHCCCS Fee-For-Service Provider Billing Manual, Ch. 10 Addendum: FQHC/RHC, (8/25/22), pg. 3, (Accessed Jan. 2023).

Telehealth may qualify as a Federally Qualified Healthcare Center/Rural Health Clinic (FQHC/RHC) visit, if all other applicable conditions in this Policy are met. Refer to AMPM Policy 670.

SOURCE: AZ Medical Policy for AHCCCS Covered Services. Telehealth and Telemedicine Ch 300, (320-I pg. 4), Approved Apr. 2022. (Accessed Jan. 2023).

ELIGIBLE SITES

Fee-for-Service Provider Manual definitions:

Distant site means “the site at which the provider delivering the service is located at the time the service is provided via telehealth (formerly hub site).”

Originating site means “the location of the AHCCCS member at the service is being furnished via telehealth or where the asynchronous service originates (formerly spoke site). This is considered the place of service.”

SOURCE: AZ Health Care Cost Containment System, AHCCCS Fee-For- Service Provider Billing Manual, Ch. 10: Individual Practitioner Services, (8/23/2022), pg. 49, & IHS/Tribal Provider Billing Manual, (10/17/2022). pg. 51-52 (Accessed Jan. 2023).

There are no Place Of Service (POS) restrictions for distant site.

SOURCE: AZ Medical Policy for AHCCCS Covered Services. Telehealth and Telemedicine Ch 300, (320-I pg. 4), Apr. 2022. (Accessed Oct. 2022).

GEOGRAPHIC LIMITS

There are no geographic restrictions for telehealth. Services delivered via telehealth are covered by AHCCCS in rural and urban/metropolitan regions.

SOURCE: AZ Medical Policy for AHCCCS Covered Services. Telehealth and Telemedicine Ch 300, (320-I pg. 1), Approved Apr. 2022 ; AZ Health Care Cost Containment System, AHCCCS Fee-For-Service Provider Billing Manual, Ch. 10: Individual Practitioner Services, (8/23/22), pg. 47, & IHS/Tribal Provider Billing Manual, (8/23/2022), pg. 50. (Accessed Jan. 2023).

FACILITY/TRANSMISSION FEE

No Reference Found

Last updated 01/03/2023

Miscellaneous

Services provided through Telehealth or resulting from a telehealth encounter are subject to all applicable statutes and rules that govern prescribing, dispensing and administering prescription medications and devices.

Privacy and confidentiality standards for Telehealth services shall adhere to all applicable statutes and policies governing healthcare services, including the Health Insurance Portability and Accountability Act (HIPAA).

SOURCE: AZ Medical Policy for AHCCCS Covered Services. Telehealth and Telemedicine Ch 300, (320-I pg. 4), Approved Apr. 2022. (Accessed Jan. 2023).

Nursing-Supported Group Homes

Administrators must ensure that policies and procedures for physical health services, habilitation services and behavioral care are established, documented and implemented to protect the health and safety of a resident that … cover telemedicine, if applicable.

SOURCE: AZ Administrative Code, R9-10-2203, (Accessed Jan. 2023).

Last updated 01/03/2023

Out of State Providers

A provider who is not licensed within the State of Arizona may provide Telehealth services to an AHCCCS member located in the state if the provider is an AHCCCS registered provider and complies with all requirements listed within A.R.S. § 36-3606.

SOURCE: AZ Medical Policy for AHCCCS Covered Services. Telehealth and Telemedicine Ch 300, (320-I pg. 2), Approved Apr. 2022. (Accessed Jan. 2023).

Last updated 01/03/2023

Overview

AHCCCS covers all major forms of telehealth services. Asynchronous (also called “store and forward”) occurs when services are not delivered in real-time, but are uploaded by providers and retrieved, perhaps to an online portal. Telephonic services (audio-only) use a traditional telephone to conduct health care appointments. Telemedicine involves interactive audio and video, in a real-time, synchronous conversation. AHCCCS also covers telehealth for remote patient monitoring and teledentistry.

SOURCE: AZ Health Care Cost Containment System. Telehealth Services, (Accessed Jan. 2023).

Arizona Health Care Cost Containment System (AHCCCS) covers medically necessary, non-experimental, and cost-effective Telehealth services provided by AHCCCS-registered providers. There are no geographic restrictions for Telehealth; services delivered via Telehealth are covered by AHCCCS in rural and urban regions. They reimburse for store-and-forward for specific specialties and for remote patient monitoring, although restrictions apply. Arizona’s Medicaid program uses an integrated managed care model with a fee-for-service delivery system for Alaska Native/American Indian populations and limited emergency services.

All services provided via telehealth must be medically necessary, non-experimental and cost-effective services.  Services are billed by the individual provider (located at the distant site).  Tele-presenter services are not billable.

SOURCE: AZ Health Care Cost Containment System, AHCCCS Fee-For-Service Provider Manual, Ch. 10: Individual Practitioner Services, (8/23/2022), pg. 47 & 49; IHS/Tribal Provider Billing Manual, p. 50 & 52 (10/17/2022), (Accessed Jan. 2023).

The Contractor and FFS programs shall cover medically necessary, non-experimental, and cost effective services delivered via Telehealth by AHCCCS registered providers for AHCCCS covered services.  Manual outlines parameters for reimbursement of live video, asynchronous, remote patient monitoring and audio-only.

SOURCE: AZ Health Care Cost Containment System, AHCCCS Medical Policy for AHCCCS Covered Services, Ch. 300, (320-I pg. 1). Approved Apr. 2022. (Accessed Jan. 2023).

Last updated 01/03/2023

Remote Patient Monitoring

POLICY

Remote Patient Monitoring:  Personal health and medical data collection from a member in one location via electronic communication technologies, which is transmitted to a provider in a different location for use in providing improved chronic disease management, care, and related support. Such monitoring shall be either synchronous (real-time) or asynchronous (store and forward).

SOURCE: AZ Health Cost Containment System, AHCCCS Contract and Policy Dictionary, 10/22, pg. 94, (Accessed Jan. 2023).

Remote patient monitoring enables the monitoring of members outside of conventional clinical settings, such as in the home.  The Contractor and FFS Programs cover both synchronous and asynchronous remote patient monitoring.

SOURCE: AZ Health Care Cost Containment System, AHCCCS Medical Policy for AHCCCS Covered Services, Ch. 300, (320-I pg. 3). Approved Apr. 2022. (Accessed Jan. 2023).

Service delivery via telehealth can be done via teledentistry, remote patient monitoring, telemedicine, or asynchronous (store and forward).

Remote Patient Monitoring is “personal health and medical data collection from a member in one location via electronic communication technologies, which is transmitted to a provider in a different location for use in providing improved chronic disease management, care, and related support. Such monitoring may be either synchronous (real-time) or asynchronous (store-and-forward).

AHCCCS will reimburse for remote patient monitoring in their fee-for-service program. Managed care organizations must abide by AHCCCS fee-for-service coverage policy.

SOURCE: AZ Health Care Cost Containment System, AHCCCS Fee-For-Service Provider Billing Manual, Ch. 10: Individual Practitioner Services, (8/23/2022), pg. 49 & IHS/Tribal Provider Billing Manual, (10/17/2022), pg. 51. (Accessed Jan. 2023).

AHCCCS covers all major forms of telehealth services. Asynchronous (also called “store and forward”) occurs when services are not delivered in real-time, but are uploaded by providers and retrieved, perhaps to an online portal. Telephonic services (audio-only) use a traditional telephone to conduct health care appointments. Telemedicine involves interactive audio and video, in a real-time, synchronous conversation. AHCCCS also covers telehealth for remote patient monitoring and teledentistry.

See chart on webpage for code set.

SOURCE: AZ Health Care Cost Containment System. Telehealth Services, (Accessed Jan. 2023).

CONDITIONS

No Reference Found

PROVIDER LIMITATIONS

No Reference Found

OTHER RESTRICTIONS

Coverage of equipment and/or supplies for remote patient monitoring is limited to when:

  1. The service being provided is an AHCCCS covered service eligible for remote monitoring; and
  2. The equipment and/or supplies are AHCCCS covered items. For additional information, refer to AMPM Policy 310-P.

The AHCCCS Telehealth code set defines which codes are billable as a remote patient monitoring service and the applicable modifier(s) and place of service providers must use when billing for a service provided through remote patient monitoring.

SOURCE: AZ Health Care Cost Containment System, AHCCCS Medical Policy for AHCCCS Covered Services, Ch. 300, (320-I pg. 3). Approved Apr. 2022. (Accessed Jan. 2023).

Last updated 01/03/2023

Store and Forward

POLICY

Telehealth – Transmission of recorded health history (e.g., pre-recorded videos, digital data, or digital images, such as xrays and photos) through a secure electronic communications system between a practitioner, usually a specialist, and a member or other practitioner, in order to evaluate the case or to render consultative and/or therapeutic services outside of a synchronous (real-time) interaction. As compared to a real-time member care, asynchronous care allows practitioners to assess, evaluate, consult, or treat conditions using secure digital transmission services, data storage services, and software solutions.

SOURCE: AZ Health Cost Containment System, AHCCCS Contract and Policy Dictionary, 10/22, pg. 107, (Accessed Jan. 2023).

Asynchronous services are rendered after the initial collection of data from the member and are provided without real-time interaction with the member.

SOURCE: AZ Health Care Cost Containment System, AHCCCS Medical Policy for AHCCCS Covered Services, Ch. 300, (320-I pg. 2). Approved Apr. 2022. (Accessed Jan. 2023).

Asynchronous (store-and-forward) is “transmission of recorded health history (e.g. pre-recorded videos, digital data, or digital images, such as x-rays and photos) through a secure electronic communications system between a practitioner, usually a specialist, and a member or other practitioner, in order to evaluate the case or to render consultative and/or therapeutic services outside of a synchronous (real-time) interaction. As compared to a real-time member care, synchronous care allows practitioners to assess, evaluate, consult, or treat conditions using secure digital transmission services, data storage services, and software solutions.”

AHCCCS will reimburse for store-and-forward in their fee-for-service program for certain services.

SOURCE: AZ Health Care Cost Containment System, AHCCCS Fee-For-Service Provider Billing Manual, Ch. 10: Professional and Technical Services, (8/23/2022), pg. 48-49 & IHS/Tribal Provider Billing Manual, (10/17/2022). pg. 51, (Accessed Jan. 2023).

Two HCPCS codes are included in this section of the 2021/2022 Fee Schedule:

  • G2010 – Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment.
  • G2012 – Brief communication technology-based service, e.g., virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion.

SOURCE: AZ Administrative Code Title 20, Ch. 5, pg. 346. (Accessed Jan. 2023).

ELIGIBLE SERVICES/SPECIALTIES

The following services are covered via asynchronous telehealth (store-and-forward):

  • Behavioral Health
  • Cardiology
  • Dermatology
  • Infectious Disease
  • Neurology
  • Ophthalmology
  • Pathology
  • Radiology

Covered behavioral health services via asynchronous telehealth can include Naturalistic Observation Diagnostic Assessment (NODA).

SOURCE: AZ Health Care Cost Containment System, AHCCCS Fee-For-Service Provider Billing Manual, Ch. 10: Professional and Technical Services, (8/23/2022), pg. 48-49 & IHS/Tribal Provider Billing Manual, (10/17/2022). pg. 50-51 (Accessed Jan. 2023).

AHCCS Medical Policy Manual

Reimbursement for this type of consultation is limited to clinically appropriate services that are provided without real-time interaction and are limited to:

  • Dermatology
  • Radiology
  • Ophthalmology
  • Pathology
  • Neurology
  • Cardiology
  • Behavioral Health
  • Infectious Disease
  • Allergy/Immunology

The AHCCCS Telehealth code set defines which codes are billable as an asynchronous service and the applicable modifier(s) and place of service providers must use when billing for a service provided via asynchronous means.

The Contractor and FFS Programs shall cover medically necessary e-consult visits, to aid in the coordination of care between a Primary Care Provider (PCP) and a specialist, and to improve timely access to specialty providers. The following conditions shall be met for the use of e-consults:

  1. Coverage is restricted to the asynchronous service types specified in this Policy.
  2. Coverage is restricted to specific e-consult codes.

The AHCCCS Telehealth code set defines which codes are billable as an e-consult service and the applicable modifier(s) and place of service providers must use when billing for a service provided through e-consult.

SOURCE: AZ Medical Policy for AHCCCS Covered Services. Telehealth and Telemedicine Ch 300, (320-I pg. 2-3), Approved Apr. 2022. (Accessed Jan. 2023).

AHCCCS covers all major forms of telehealth services. Asynchronous (also called “store and forward”) occurs when services are not delivered in real-time, but are uploaded by providers and retrieved, perhaps to an online portal. Telephonic services (audio-only) use a traditional telephone to conduct health care appointments. Telemedicine involves interactive audio and video, in a real-time, synchronous conversation. AHCCCS also covers telehealth for remote patient monitoring and teledentistry.

SOURCE: AZ Health Care Cost Containment System. Telehealth Services, (Accessed Jan. 2023).

GEOGRAPHIC LIMITS

There are no geographic restrictions for telehealth. Services delivered via telehealth are covered by AHCCCS in rural and urban regions.

SOURCE: AZ Medical Policy for AHCCCS Covered Services. Telehealth and Telemedicine Ch 300, (320-I pg. 1), Approved Apr. 2022 ; AZ Health Care Cost Containment System, AHCCCS Fee-For-Service Provider Billing Manual, Ch. 10: Individual Practitioner Services, (8/23/22), pg. 47, & IHS/Tribal Provider Billing Manual, (10/17/2022), pg. 510 (Accessed Jan. 2023).

FACILITY/TRANSMISSION FEE

No Reference Found

Professional Requirements

Last updated 01/03/2023

Consent Requirements

Before a health care provider delivers health care through telehealth, the treating health care provider shall obtain verbal or written informed consent, including by electronic means, from the patient or the patient’s health care decision maker. If the informed consent is obtained verbally, the health care provider shall document the consent on the patient’s medical record.

The consent requirement does not apply in the following circumstances:

  • If the telehealth interaction does not take place in the physical presence of the patient.
  • In an emergency situation in which the patient or the patient’s health care decision maker is unable to give informed consent.
  • To the transmission of diagnostic images to a health care provider serving as a consultant or the reporting of diagnostic test results by that consultant.

SOURCE: Arizona Revised Statute Sec. 36-3602 (Accessed Jan. 2023).

Last updated 01/03/2023

Cross State Licensing

A health care provider who is not licensed in Arizona may provide telehealth services to a person located in Arizona if the health care provider complies with all of the following:

  1. Registers with the state’s applicable health care provider regulatory board or agency that licenses comparable health care providers on an application prescribed by the board or agency that contains certain elements (see law text).
  2. Before prescribing a controlled substance to a patient, registers with the controlled substances prescription monitoring program.
  3. Pays the registration fee as determined by the applicable health care provider regulatory board or agency.
  4. Holds a current, valid and unrestricted license to practice in another state that is substantially similar to a license issued in Arizona to a comparable health care provider and is not subject to any past or pending disciplinary proceedings in any jurisdiction. The health care provider shall notify the applicable health care provider regulatory board or agency within five days after any restriction is placed on the health care provider’s license or any disciplinary action is initiated or imposed. The health care provider regulatory board or agency registering the health care provider may use the national practitioner databank to verify the information submitted.
  5. Acts in full compliance with all applicable laws and rules of this state, including scope of practice, laws and rules governing prescribing, dispensing and administering prescription drugs and devices, telehealth requirements and the best practice guidelines adopted by the telehealth advisory committee on telehealth best practices established by section 36-3607.
  6. Complies with all existing requirements of Arizona and any other state in which the health care provider is licensed regarding maintaining professional liability insurance, including coverage for telehealth services provided in Arizona.
  7. Consents to this state’s jurisdiction for any disciplinary action or legal proceeding related to the health care provider’s acts or omissions under this article.
  8. Follows Arizona’s standards of care for that particular licensed health profession.
  9. Annually updates the health care provider’s registration for accuracy and submits to the applicable health care provider regulatory board or agency a report with the number of patients the provider served in Arizona and the total number and type of encounters for the preceding year

A health care provider who is registered pursuant to this section may not:

  • Open an office in this state, except as part of a multistate provider group that includes at least one health care provider who is licensed in this state through the applicable health care provider regulatory board or agency.
  • Provide in-person health care services to persons located in this state without first obtaining a license through the applicable health care provider regulatory board or agency.

A health care provider who is not licensed to provide health care services in Arizona but who holds an active license to provide health care services in another jurisdiction and who provides telehealth services to a person located in Arizona is not subject to the registration requirements of this section if either of the following applies:

  • The services are provided under one of the following circumstances:
    • In response to an emergency medication condition.
    • In consultation with a health care provider who is licensed in Arizona and who has the ultimate authority over the patient’s diagnosis and treatment.
    • To provide after-care specifically related to a medical procedure that was delivered in person in another state.
    • To a person who is a resident of another state and the telehealth provider is the primary care provider or behavioral health provider located in the person’s state of residence.
  • The health care provider provides fewer than ten telehealth encounters in a calendar year.

SOURCE: AZ Revised Statute Sec. 36-3606 (Accessed Jan. 2023).

Licensing requirements do not apply to:

  • A doctor of medicine residing in another jurisdiction who is authorized to practice medicine in that jurisdiction, if the doctor engages in actual single or infrequent consultation with a doctor of medicine licensed in this state and if the consultation regards a specific patient or patients.
  • A doctor of medicine who is licensed to practice in another jurisdiction if the doctor engages in the practice of medicine that is limited to patients with whom the doctor has an already established doctor-patient relationship and who reside outside this jurisdiction when both the doctor and the patient are physically in this state for not more than sixty consecutive days.  For the purposes of this paragraph, “patient” means a person who is not a resident of this state and who is an athlete or a professional entertainer.

SOURCE: AZ Revised Statute Sec. 32-1421. (Accessed Jan. 2023).

Behavioral health providers delivering care via telepractice to Arizona patients must be licensed by the Arizona Board of Behavioral Health Examiners. Arizona providers offering care to out of state residents “shall comply with not only A.R.S. Title 32, Chapter 33, and this Chapter but also the laws and rules of the jurisdiction in which the client is located.”

SOURCE: AZ Administrative Code, Title 4, Ch. 6, R4-6-1106. Telepractice, p. 27 (Accessed Jan. 2023)

Board of Physician Assistants

The Board establishes and shall collect a fee to register as an out-of-state health care provider of telehealth services.

SOURCE:  AZ Administrative Code, Title 4, Ch. 17, R4-17-204, (Accessed Jan. 2023).

Board of Psychologist Examiners

The Board establishes and shall collect a fee to register as an out-of-state health care provider of telehealth services.

SOURCE: AZ Administrative Code, R4-26-108, (Accessed Jan. 2023).

Board of Physical Therapy

The Board establishes and shall collect a fee to register as an out-of-state health care provider of telehealth services.

SOURCE: AZ Administrative Code, R4-24-107, (Accessed Jan. 2023).

Board of Medicine

The Board establishes and shall collect a fee to register as an out-of-state health care provider of telehealth services.

SOURCE: AZ Administrative Code, R4-16-205, (Accessed Jan. 2023).

Board of Osteopathic Examiners in Medicine and Surgery

The Board establishes and shall collect Annual Registration as an out-of-state health care provider of telehealth services.

SOURCE: AZ Administrative Code, R4-22-103, (Accessed Jan. 2023).

Last updated 01/03/2023

Definitions

“Telehealth” means:

  • The interactive use of audio, video or other electronic media, including asynchronous store-and-forward technologies and remote patient monitoring technologies, for the practice of health care, assessment, diagnosis, consultation or treatment and the transfer of medical data.
  • Includes the use of an audio-only telephone encounter between the patient or client and health care provider if an audio-visual telehealth encounter is not reasonably available due to the patient’s functional status, the patient’s lack of technology or telecommunications infrastructure limits, as determined by the health care provider.
  • Does not include the use of a fax machine, instant messages, voice mail or email.

SOURCE: AZ Revised Statute Sec. 36-3601 (Accessed Jan. 2023)

Board of Psychologist Examiners

“Telepractice” means providing psychological services through interactive audio, video or electronic communication that occurs between the psychologist and the patient or client, including any electronic communication for diagnostic, treatment or consultation purposes in a secure platform, and that meets the requirements of telehealth pursuant to section 36-3602. Telepractice includes supervision.

SOURCE: AZ Revised Statute Sec. 32-2061 (Accessed Jan. 2023).

Last updated 01/03/2023

Licensure Compacts

Member of Interstate Medical Licensure Compact.

SOURCE: Interstate Medical Licensure Compact, (Accessed Jan. 2023).

Member of the Interjurisdictional Compact of the Association of State and Provincial Psychology Boards (PSYPACT).

SOURCE: PSYPACT  (Accessed Jan. 2023).

Member of Nurse Licensure Compact.

SOURCE:  Nurse Licensure Compact (Accessed Jan. 2022).

Member of Physical Therapy Compact.

SOURCE:  Physical Therapy Compact (Accessed Jan. 2023).

Member of the Occupational Therapy Licensure Compact.

SOURCE: Occupational Therapy Licensure Compact. (Accessed Jan. 2023).

* See Compact websites for implementation and license issuing status and other related requirements.

Last updated 01/03/2023

Miscellaneous

Arizona established a telehealth advisory committee on telehealth best practices in order to adopt telehealth best practice guidelines and recommendations regarding the health care services that may be appropriately provided through an audio-only telehealth format and make updates, when applicable.

Beginning October 1, 2021 and on or before the first of each month thereafter, each health care provider regulatory board or agency shall submit to the telehealth advisory committee on telehealth best practices established by section 36-3607 a report identifying the number and type of out-of-state health care providers who have applied for registration pursuant to section 36-3606 and the number and type of out-of-state health care providers whose registration pursuant to section 36-3606 has been approved.

SOURCE: Ariz. Code 36-3608 [repeal effective Jan. 1, 2026] (Accessed Jan. 2023).

Last updated 10/19/2022

Online Prescribing

Medical Board

Unprofessional conduct includes prescribing, dispensing or furnishing a prescription medication or a prescription-only device to a person unless the licensee first conducts a physical or mental health status examination of that person or has previously established a doctor-patient relationship. The physical or mental health status examination may be conducted through telehealth with a clinical evaluation that is appropriate for the patient and the condition with which the patient presents, unless the examination is for the purpose of obtaining a written certification from the physician for the purposes of title 36, chapter 28.1. This subdivision does not apply to:

  • A physician who provides temporary patient supervision on behalf of the patient’s regular treating licensed health care professional or provides a consultation requested by the patient’s regular treating licensed health care professional.
  • Emergency medical situations as defined in section 41-1831.
  • Prescriptions written to prepare a patient for a medical examination.
  • Prescriptions written or prescription medications issued for use by a county or tribal public health department for immunization programs or emergency treatment or in response to an infectious disease investigation, public health emergency, infectious disease outbreak or act of bioterrorism. For the purposes of this item, “bioterrorism” has the same meaning prescribed in section 36-781.
  • Prescriptions written or antimicrobials dispensed to a contact as defined in section 36-661 who is believed to have had significant exposure risk as defined in section 36-661 with another person who has been diagnosed with a communicable disease as defined in section 36-661 by the prescribing or dispensing physician.
  • Prescriptions written or prescription medications issued for administration of immunizations or vaccines listed in the United States centers for disease control and prevention’s recommended immunization schedule to a household member of a patient.
  • Prescriptions for epinephrine auto-injectors written or dispensed for a school district or charter school to be stocked for emergency use pursuant to section 15-157 or for an authorized entity to be stocked pursuant to section 36-2226.01.
  • Prescriptions written by a licensee through a telehealth program that is covered by the policies and procedures adopted by the administrator of a hospital or outpatient treatment center.
  • Prescriptions for naloxone hydrochloride or any other opioid antagonist approved by the United States food and drug administration that are written or dispensed for use pursuant to section 36-2228 or 36-2266.
  •  Performing office based surgery using sedation in violation of board rules.
  • Practicing medicine under a false or assumed name in this state.

SOURCE: Arizona Revised Statute Sec. 32-1401 (Accessed Jan. 2023).

Osteopathic Physicians and Surgeons

Prescribing, dispensing or furnishing a prescription medication or a prescription-only device to a person if the licensee has not conducted a physical or mental health status examination of that person or has not previously established a physician-patient relationship.  The physical or mental health status examination may be conducted through telehealth as defined in section 36-3601 with a clinical evaluation that is appropriate for the patient and the condition with which the patient presents, unless the examination is for the purpose of obtaining a written certification from the physician for the purposes of title 36, chapter 28.1. This paragraph does not apply to:

  • Emergencies.
  • A licensee who provides patient care on behalf of the patient’s regular treating licensed health care professional or provides a consultation requested by the patient’s regular treating licensed health care professional.
  • Prescriptions written or antimicrobials dispensed to a contact as defined in section 36-661 who is believed to have had significant exposure risk as defined in section 36-661 with another person who has been diagnosed with a communicable disease as defined in section 36-661 by the prescribing or dispensing physician.
  • Prescriptions for epinephrine auto-injectors written or dispensed for a school district or charter school to be stocked for emergency use pursuant to section 15-157 or for an authorized entity to be stocked pursuant to section 36-2226.01.
  • Prescriptions written by a licensee through a telehealth program that is covered by the policies and procedures adopted by the administrator of a hospital or outpatient treatment center.
  • Prescriptions for naloxone hydrochloride or any other opioid antagonist approved by the United States food and drug administration that are written or dispensed for use pursuant to section 36-2228 or 36-2266.

SOURCE: Arizona Revised Statute Sec. 32-1854 (Accessed Jan. 2023).

For schedule II drugs, a health care provider regulatory board or agency may not enforce any statute, rule or policy that would require a health care provider who is licensed by that board or agency and who is authorized to write prescriptions or dispense or administer prescription drugs and devices to provide an in-person examination of the patient before issuing a prescription except as specifically prescribed by federal law. A physical or mental health status examination may be conducted during a telehealth encounter. Schedule II drugs may be prescribed only after an in-person or audio-visual examination and only to the extent allowed by federal and state law.

Services provided through telehealth are subject to this state’s laws and rules governing the health care provider’s scope of practice and the practice guidelines adopted by the telehealth advisory committee on telehealth best practices established by section 36-3607.

SOURCE: Arizona Revised Statute Sec. 36-3602 (Accessed Jan. 2023).

Naturopathic Physicians

Prescribing, dispensing or furnishing a prescription medication or a prescription-only device as defined in section 32-1901 to a person unless the licensee first conducts a physical examination of that person or has previously established a doctor-patient relationship. The physical examination may be conducted during a real-time telemedicine encounter with audio and video capability unless the examination is for the purpose of obtaining a written certification from the physician for the purposes of title 36, chapter 28.1. This subdivision does not apply to:

  • A licensee who provides temporary patient supervision on behalf of the patient’s regular treating licensed health care professional.
  • An emergency medical situation as defined in section 41-1831.
  • Prescriptions written to prepare a patient for a medical examination.
  • Prescriptions written or prescription medications issued for use by a county or tribal public health department for immunization programs or emergency treatment or in response to an infectious disease investigation, a public health emergency, an infectious disease outbreak or an act of bioterrorism. For the purposes of this item, “bioterrorism” has the same meaning prescribed in section 36-781.
  • Prescriptions written or antimicrobials dispensed to a contact as defined in section 36-661 who is believed to have had significant exposure risk as defined in section 36-661 with another person who has been diagnosed with a communicable disease as defined in section 36-661 by the prescribing or dispensing physician.
  • Prescriptions written by a licensee through a telemedicine program that is covered by the policies and procedures adopted by the administrator of a hospital or outpatient treatment center.
  • If medical treatment is considered experimental or investigational, failing to include in a patient’s record a consent to treatment document that is signed by the patient or the patient’s parent or legal guardian and that indicates that the patient or the patient’s parent or legal guardian has been informed of the risk of any treatment to be provided and the expected cost of that treatment.
  • When issuing a written certification (see regulation for more details).

SOURCE: Arizona Revised Statute Sec. 32-1501, (Accessed Jan. 2023).

Pharmacy

Unprofessional conduct includes knowingly dispensing a drug on a prescription order that was issued in the course of the conduct of business of dispensing drugs pursuant to diagnosis by mail or the internet, unless the order was any of the following: …

  • Written by a licensee through a telehealth program that is covered by the policies and procedures adopted by the administrator of a hospital or outpatient treatment center.
  • Written pursuant to a physical or mental health status examination that was conducted through telehealth as defined in section 36-3601 and consistent with federal law.

SOURCE: Arizona Revised Statute Sec. 1901.01.01  (Accessed Jan. 2023).

A health care provider shall not use telehealth to provide an abortion.

SOURCE: Arizona Revised Statute Sec. 36-3604  (Accessed Jan. 2023).

If a health professional believes that a patient requires more than ninety morphine milligram equivalents per day and the patient is not exempt from the limit pursuant to subsection B of this section, the health professional shall first consult with a physician who is licensed pursuant to chapter 13 or 17 of this title and who is board-certified in pain, or an opioid assistance and referral call service, if available, that is designated by the department of health services. The consultation may be done by telephone or through telehealth.

SOURCE: Arizona Revised Statute Sec. 32-3248.01, (Accessed Jan. 2023).

Last updated 01/03/2023

Professional Board Standards

Board of Psychologist Examiners

SOURCE: AZ Reg. Sec. R4-26-109. (Accessed Jan. 2023).

Board of Behavioral Health Examiners

SOURCE: AZ Reg. Sec. R4-6-1106. (Accessed Jan. 2023).

Consistent with the best practice guidelines adopted by the telehealth advisory committee on telehealth best practices established by section 36-3607, a health care provider shall make a good faith effort in determining both of the following:

Whether a health care service should be provided through telehealth instead of in person. The health care provider shall use the health care provider’s clinical judgment in considering whether the nature of the services necessitates physical interventions and close observation and the circumstances of the patient, including diagnosis, symptoms, history, age, physical location and access to telehealth.

The communication medium of telehealth and, whenever reasonably practicable, the telehealth communication medium that allows the health care provider to most effectively assess, diagnose and treat the patient. Factors the health care provider may consider in determining the communication medium include the patient’s lack of access to or inability to use technology or limits in telecommunication infrastructure necessary to support interactive telehealth encounters.

SOURCE: Arizona Revised Statute 36-3605, (Accessed Jan. 2023).

Federally Qualified Health Center (FQHC)

Last updated 01/03/2023

Definition of Visit

“FQHC/RHC visit” means: A face-to-face encounter with a licensed AHCCCS registered practitioner during which an AHCCCS-covered ambulatory service is provided when that service is not incident to another service.

SOURCE: AZ Health Care Cost Containment System, AHCCCS Fee-For-Service Provider Billing Manual, Ch. 10 Addendum: FQHC/RHC, (8/25/22), pg. 1, (Accessed Oct. 2022). 

Last updated 10/19/2022

Eligible Distant Site

Telehealth and telemedicine may qualify as a FQHC/RHC visit if it meets the requirements as specified in AMPM Policy 320-I.  To qualify as a reimbursable telehealth visit, claims with procedure code T1015 must additionally include another eligible code from the AHCCCS Telehealth Code Set.

SOURCE: AZ Health Care Cost Containment System, AHCCCS Fee-For-Service Provider Billing Manual, Ch. 10 Addendum: FQHC/RHC, (8/25/22), pg. 3, (Accessed Jan. 2023). 

Last updated 01/03/2023

Eligible Originating Site

Not explicitly on list, however there is not a definitive list of eligible originating sites.

See: AZ Medicaid Live Video Eligible Sites

Last updated 01/03/2023

Facility Fee

CCHP has found no evidence that AZ Medicaid reimburses a telehealth facility/originating site fee for any telehealth entity.

See: AZ Medicaid Live Video Facility/Transmission Fee

Last updated 01/03/2023

Home Eligible

No reference found.

Last updated 01/03/2023

Modalities Allowed

Live Video

Manual specifies that telehealth and telemedicine may qualify as an FQHC/RHC visit if it meets the requirements of the Telehealth and Telemedicine AMPM Manual 320-I.  Live video is reimbursed for medically necessary, non-experimental and cost-effective services.

See: AZ Medicaid Live Video

Store-and-Forward

Manual specifies that telehealth and telemedicine may qualify as an FQHC/RHC visit if it meets the requirements of the Telehealth and Telemedicine AMPM Manual 320-I.  Reimbursement is provided for store-and-forward in manual section 320-I.  See: AZ Medicaid Store-and-Forward.  However, because it is not face-to-face and doesn’t meet the definition of a FQHC visit, it is unclear whether or not this is reimbursable.

Remote Patient Monitoring

Manual specifies that telehealth and telemedicine may qualify as an FQHC/RHC visit if it meets the requirements of the Telehealth and Telemedicine AMPM Manual 320-I.  Reimbursement is provided for remote patient monitoring in manual section 320-I.  See: AZ Medicaid Remote Patient Monitoring.  However, because it is not face-to-face and doesn’t meet the definition of a FQHC visit, it is unclear whether or not this is reimbursable.

Audio-Only

Manual specifies that telehealth and telemedicine may qualify as an FQHC/RHC visit if it meets the requirements of the Telehealth and Telemedicine AMPM Manual 320-I.  Reimbursement is provided for audio-only coverage for certain codes in manual section 320-I.  See: AZ Medicaid Email, Phone and Fax.  However, because it is not face-to-face and doesn’t meet the definition of a FQHC visit, it is unclear whether or not this is reimbursable.

Last updated 01/03/2023

Patient-Provider Relationship

No reference found.

Last updated 01/03/2023

PPS Rate

No reference found.

Last updated 01/03/2023

Same Day Encounters

Multiple encounters with more than one practitioner within the same discipline, i.e., dental, physical, behavioral health, or with the same practitioner and which take place on the same day and at a single location, constitute a single visit unless the patient, subsequent to the first encounter, suffers illness or injury requiring additional diagnosis or treatment. In this circumstance, the subsequent encounter is considered a separate visit. A service which is provided incident to another service, whether or not on the same day or at the same location, is considered to be part of the visit and is not reimbursed separately.

Multiple visits on the same day within the same discipline which are distinct based upon the FQHC/RHC visit definition above must be identified by billing the T1015 visit code for the same-day subsequent visit with a modifier 25 to indicate a distinct and separate visit.

SOURCE: AZ Health Care Cost Containment System, AHCCCS Fee-For-Service Provider Billing Manual, Ch. 10 Addendum: FQHC/RHC, (8/25/22), pg. 1 & 3, (Accessed Jan. 2023).