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:
- The service being provided is an AHCCCS covered service eligible for remote monitoring; and
- 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:
- Coverage is restricted to the asynchronous service types specified in this Policy.
- 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