PDF Version
TO: Physicians, CRNPs, PAs, FQHCs, RHCs, Optometrists,
ADPH, CRS
As Medicaid
continues to monitor the outbreak of the Coronavirus Disease 2019 (COVID-19) in
Alabama, we are extending policies to allow for additional codes to be
delivered via telemedicine according to the Alert published on March 18, 2020
and May 1, 2020. Furthermore, Medicaid is allowing providers to bill for EPSDT
screenings and evaluation and management visits on the same day of service.
Please see
changes below:
- The following codes may be
performed and billed via telemedicine utilizing place of service 02 and
the modifier CR on the claims:
96110
96127
96160
96161
98966-98967**
D0145
**Will not
count toward the annual physician office visit limit
- Medicaid is allowing the following EPSDT periodic
screenings (well child checkups) codes to be billed via telemedicine,
knowing not all components of the screening may be completed via telemedicine
but will be completed in person when appropriate with no additional
payment. Providers should bill with place of service 02 and modifiers CR
and 52.
99381EP –
99385EP
99391EP –
99395EP
** Follow
up visits in-person should occur as soon as possible to complete the remaining exam
screening components. These exam visits can be billed for tracking purposes
utilizing CPT 99201EP-99205 EP and 99211EP – 99215EP with modifier 52.
Providers
are encouraged to continue in-person well child visits to receive necessary
immunizations and other screenings of infants and young children (through 24
months of age) whenever possible.
- Medicaid is allowing the following procedure codes
for in-person EPSDT screenings (well child checkups) and for evaluation
and management (E/M office visits) visits to be billed on the same day of
service with modifier 25 appended to codes 99201EP – 99215EP:
Well
checkups: 99381EP – 99385EP, 99391EP – 99395EP
E/M
visits: 99201EP – 99205EP, 99211EP - 99215EP
As a reminder, providers should bill 99211EP – 99215EP for interperiodic screenings.
The effective
dates for this Alert are March 16, 2020 - May 30, 2020, or at
the conclusion of the COVID-19 National emergency, whichever occurs first. Providers can begin
submitting claims on May 22, 2020.
During the
COVID-19 emergency, it is important to file claims as quickly as possible to
ensure payment from Medicaid is made to Medicaid providers close to the date of
service. The Centers for Medicare and Medicaid Services has increased the
federal matching percentage for the emergency time frame, but states can only
receive the increased match on claims that are paid during the emergency.
Providers should include appropriate COVID-19 diagnosis code(s) on claims submitted
to help with tracking of COVID-19.
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: elizabeth.huckabee@medicaid.alabama.gov,
shauna.williams@medicaid.alabama.gov,
beverly.churchwell@medicaid.alabama.gov
The Current Procedural Terminology (CPT) and Current Dental Terminology
(CDT) codes descriptors, and other data are copyright © 2020
American Medical Association and © 2020 American Dental Association (or such other date publication of CPT and
CDT). All rights reserved. Applicable FARS/DFARS apply.