Page 21 State Telehealth Laws and Reimbursement Policies A Comprehensive Scan of the 50 States and District of Columbia
P. 21
Center for Connected Health Policy
STATE LAW/REGULATIONS MEDICAID PROGRAM
Services, p. 39 (Nov. 2014).
Store and Forward Reimbursement
The definition of “telemedicine”, which describes Fee for Service
telemedicine as occurring in the “physical presence” of AHCCCS will reimburse for store-and-forward in their
the patient, would exclude store and forward. fee-for-service program. The same services are
covered for store and forward, as for real time.
Source: AZ Admin. Code Sec. R20-6-1902 (2012).
Real time telemedicine is the only type of
reimbursement available in the field of Behavioral Health
Services.
Source: AZ Health Care Cost Containment System, AHCCCS Fee-
For- Service Provider Manual, Ch. 10: Professional and Technical
Services, p. 38 (Nov. 2014).
Fee for Service and Managed Care
In the Managed Care program, AHCCCS only covers for
store and forward (and is subject for review) the
following:
• Dermatology
• Radiology
• Ophthalmology
• Pathology
Source: Arizona Health Care Cost Containment System. AHCCCS
Medical Policy Manual for AHCCCS Covered Services, Ch. 300,
Policy 320 Services With Special Circumstances, p. 178 (Apr.
2012).
The following exceptions may be eligible for
reimbursement by managed care, but are not
considered a “telemedicine service”:
• A provider in the role of tele-presenter may be
providing a separately billable service, such as
an electrocardiogram or an X-ray. The service is
covered, but not the tele-presenting.
• A consulting distant-site provider may offer a
service that does not require real-time patient
interaction. Reimbursement only for
dermatology, radiology, ophthalmology, and
pathology. It is subject to review by AHCCCS
Medical Management.
• When a patient in a rural area presents within
three hours of onset of stroke symptoms,
AHCCCS will reimburse the consulting
neurologist if the consult is placed for assistance
in determining appropriateness of thrombolytic
therapy even when the patients’ condition is
such that real-time video interaction cannot be
achieved.
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