Effective for dates of service January 16, 2012, and thereafter, physicians allowed to participate in telemedicine services include those with an Alabama license, regardless of location.  This includes physicians located outside the state of Alabama as long as they maintain an Alabama license and enroll with the Alabama Medicaid Program.

Medicaid requires that the physician be enrolled with the specialty of 931 (telemedicine) in order to participate in the telemedicine program.  The physician must submit the Telemedicine Services Agreement/Certification form which can be found on our website in the Forms library at: http://medicaid.alabama.gov/documents/5.0_Resources/5.4_Forms_Library/5.4.6_Provider_Enrollment/5.4.6_Web_Portal_App_Telemed_Servcs_Agree_1-5-12.pdf

Procedure codes covered for telemedicine services include; consultations (99241-99245, 99251-99255), office or other outpatient visits (99201-99205, 99211-99215), individual psychotherapy (90804-90809), psychiatric diagnostic (90801), and neurobehavioral status exam (96116). All procedure codes billed for telemedicine services must be billed with modifier GT (via interactive audio and video telecommunications system).

Telemedicine services require the physician to obtain prior consent from the recipient before services are rendered.  Telemedicine services will count as part of each recipient’s benefit limit of 14 annual physician office visits currently allowed.  A sample recipient consent form can be found on our website in the Forms library at:

http://medicaid.alabama.gov/documents/5.0_Resources/5.4_Forms_Library/5.4.6_Provider_Enrollment/Fillable_Forms/5.4.6_AL_Med_Telemedicine_Recipient_Consent_Form_Fillable_6-30-11.pdf

The Agency will not reimburse providers for origination site or transmission fees.

See further details in the April update of Chapter 28 of the Alabama Medicaid Provider Manual on the website at www.medicaid.alabama.gov