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TO: Physicians, CRNPs, PAs, FQHCs, RHCs, Psychologists,
Licensed Professional Counselors, Associate Licensed Counselors, Licensed Marriage
and Family Therapists, Licensed Master Social Workers, and Licensed Independent
and Clinical Social Workers
As the Agency continues
to monitor the outbreak of the Coronavirus Disease 2019 (COVID-19) in Alabama,
we are extending telemedicine to ease access to appropriate medical services
for certain codes for your established patients who are recipients of Alabama
Medicaid.
What does the
extension include?
The extension of telemedicine
services is effective March 16, 2020. This extension allows
clinicians to provide medically necessary services that can be appropriately
delivered via telecommunication services including telephone consultations. The
extension also allows some behavioral health services to be appropriately
delivered via telecommunication services including telephone consultations. These
actions will be effective for one month, expiring on dates of service April
16, 2020. It will be reevaluated for a continuance as needed.
This is
applicable for recipients who wish to receive their care remotely
and limit their exposure to the virus. It can also serve as an initial
screening for recipients who may need to be tested for COVID-19. For guidance
on coronavirus testing, please refer to the Centers for Disease Control & Prevention, Alabama Department
of Public Health, and Alabama Department
of Mental Health websites.
Recipient copayments
will apply according to the Medicaid recipient handbook. A provider may not
deny services to an eligible recipient due to the recipient’s inability to pay
the copayment amount imposed.
Which types of
providers can perform telemedicine?
This applies to physicians,
nurse practitioners, physician assistants, and dental providers who currently
receive Alabama Medicaid payment.
How does this
affect behavioral health?
Behavioral health
providers such as: psychologists,
licensed professional counselors, associate licensed counselors, licensed
marriage and family therapists, licensed master social workers, and licensed
independent and clinical social workers are included in this policy extension.
Which services
can be performed?
Telemedicine is
appropriate for consultations and visits for either low complexity, routine or
ongoing evaluation and management. This would include acute illnesses, chronic
disease management, behavioral health, or emergency dental services that, based
on the provider’s medical judgment, can be managed by utilizing telecommunication
services.
Which procedure
codes, modifiers, and place of service codes apply?
Medical providers
should bill established-patient evaluation and management codes 99211, 99212
and 99213. Psychologists and behavioral health professionals should bill 90832,
90834, 90837, 90846, 90847 and H2011. A dental provider should bill D0140.
Standard documentation applies and additional billing justification must be
documented in the recipients’ medical records.
For Medicaid to ensure
proper reporting with the Centers for Medicare and Medicaid Services (CMS), it is
necessary to file the claim with place of service ‘02’ (telemedicine) and a
modifier of ‘CR’ for catastrophic/disaster to assist with claims tracking.
Providers should
only bill for telecommunications when the provider speaks directly with the recipient.
Providers should not bill Alabama Medicaid for services when, for
example, a nurse speaks to the recipient, even if the provider was consulted.
How will the
telemedicine services agreements and recipient consent forms apply?
Effective for
dates of service March 16, 2020 – April 16, 2020 the telemedicine services
agreement and recipient consent forms will be waived. However, the provider
must receive verbal consent from the recipient, and the provider must document that
consent in the medical record.
When can a provider
submit a claim?
Providers should
begin submitting claims on March 20, 2020.
Will the 14 office
visits limit apply?
Yes. The 14 office
visit benefit will apply.
Will the dental
examinations limit apply?
Yes
This Alert is an
interpretation based on guidance from (CMS) as it relates to the COVID-19
pandemic emergency.
Alabama Medicaid will
review and verify that requirements for the extension of telemedicine services
are being met. Payments to providers that do not meet the specifications are subject
to recoupment.
If you have
questions, please visit the Medicaid website at www.medicaid.alabama.gov, or call
the Medicaid Fiscal Agent at 1.800.688.7989.
Contacts:
danny.rush@medicaid.alabama.gov,
beverly.churchwell@medicaid.alabama.gov,
karen.watkins-smith@medicaid.alabama.gov,
elizabeth.huckabee@medicaid.alabama.gov