Telemedicine / Telehealth Coverage and Origination Site Policy
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Governs Alabama Medicaid coverage, provider requirements, eligible services, delivery standards, and originating site rules for telemedicine/telehealth services for Medicaid recipients and enrolled providers.
No material clinical or coverage changes in this revision.
Coverage Criteria for Telemedicine Services
General coverage criteria for telemedicine services
Covered when ALL of the following are met
General telemedicine coverage
Covered when ALL of the following are met
Origination site facility fee
Origination site facility fee covered when ALL of the following are met
Prescribing controlled substances
Controlled substances via telemedicine may be prescribed when ALL of the following are met
The following telemedicine interactions are examples of services not eligible for reimbursement: chart reviews, electronic mail messages between providers and recipients, facsimile transmissions, and consultations between two providers. Also excluded are services that are not directly provided by an enrolled provider or office staff, services that are not normally charged during an office visit, and services that are not specifically listed in Provider Billing Manual chapters.
Additional examples of excluded telemedicine services include internet-based communications that are not HIPAA-compliant or secure (for example, consumer platforms like Skype or FaceTime), and any electronic communications between provider and recipient that meet the exclusions list above. Exceptions may be granted only under separate guidance such as during a declared public health emergency.
Use of unsecured consumer platforms or other communications that are not HIPAA-compliant (explicitly noted examples include Skype and FaceTime) is not eligible for reimbursement. Providers must use secure, HIPAA-compliant telecommunications for telemedicine visits unless separate emergency guidance states otherwise.
Codes, Modifiers, and Billing
| 99211-99215 | Office visit codes for established patients (Eye Care) |
| 99202-99205 | Office or other outpatient visits for recipients ages 21 and older (CRNPs/PAs) |
| 99211-99215 | Office or other outpatient visits / EPSDT interperiodic screenings (CRNPs/PAs) |
| 99221-99223 | Initial hospital inpatient or observation care |
| 99231-99233 | Subsequent hospital inpatient or observation care |
| 99234-99236 | Hospital inpatient or observation care |
| 99238-99239 | Hospital inpatient or observation discharge day management |
| 99242-99245 | Office or other outpatient consultation |
| 99252-99255 | Inpatient or observation consultation |
| 99202-99205 | Office or other outpatient visits for recipients ages 21 and older (Physician services) |
| 99211-99215 | EPSDT interperiodic screenings / office visits (Physician services) |
| 99221-99223 | Initial hospital inpatient or observation care |
| 99231-99233 | Subsequent hospital inpatient or observation care |
| 99234-99236 | Hospital inpatient or observation care |
| 99238-99239 | Hospital inpatient or observation discharge day management |
| 99242-99245 | Office or other outpatient consultation |
| 99252-99255 | Inpatient or observation consultation |
| 97151 | Behavior Identification Assessment |
| 97152 | Observational F/U assessment |
| 0362T | Exposure Behavioral F/U Assessment |
| 97153 | Adaptive Behavior Treatment / Group Adaptive Behavior Treatment |
| 97154 | Social Skills Group |
| 0373T | Exposure Adaptive Behavior Treatment |
| 97155 | Adaptive Behavior Modification |
| 97156 | Family Adaptive Behavior Treatment Guidance |
| 97157 | Multiple Family, Group Treatment Guidance |
| 90791, 96130, 96131 | Psychiatric evaluation |
| 90832, 90834, 90837, 90846, 90847, 90853, 90849 | Psychotherapy |
| 96136, 96137, 96138, 96139, 96146 | Psychological testing |
| H0002, H0004, H0031-HR | Assessments |
| H0034 | Medication Monitoring |
| H0038 | Peer support services (with appropriate modifiers) |
| H0040-HQ | Program for Assertive Community Treatment |
| H2011 | Crisis intervention |
| H0032 | Treatment plan review |
| H0046 | Mental health care coordination |
| No codes listed |
| Q3014 | telemedicine origination site facility fee |
| GT | modifier for telemedicine via audio and visual telecommunications |
| FQ | modifier to designate audio-only telemedicine claim |
| 99201-99205 | Office/outpatient visit codes requiring BMI at least once per calendar year |
| 99211-99215 | Office/outpatient visit codes requiring BMI at least once per calendar year |
| 99241-99245 | Office consultation codes requiring BMI at least once per calendar year |
| 99382-99385 | EPSDT preventive codes requiring BMI at least once per calendar year |
| 99392-99395 | EPSDT preventive codes requiring BMI at least once per calendar year |
Provider Requirements, Documentation, and Billing Actions
Obtain and document patient consent before telemedicine visits
Providers must obtain prior written or verbal consent from the recipient before telemedicine services are rendered; consent must be documented in the recipient's medical record and the provider must identify the patient's consent for the use of telemedicine delivery of health care services.
- Consent (written or verbal) must be obtained prior to services.
- Document consent in the medical record.
Check procedure-level prior authorization — telemedicine delivery does not exempt services
Delivery via telemedicine alone does not create a separate prior authorization requirement; however, prior authorization may still be required for the specific procedure codes billed per the Provider Billing Manual.
- Do not assume telemedicine delivery removes prior auth — check the Provider Billing Manual chapter for the billed service.
- Prior authorization requirements apply per procedure code, not based solely on telemedicine modality.
Bill only as the rendering provider and maintain Telemedicine enrollment
Only the provider rendering the telemedicine services may submit claims for reimbursement; providers must be enrolled with Medicaid (specialty type 931) and indicate an in-state or qualifying bordering state practice address from which telemedicine services are provided.
- Only the rendering provider may bill for telemedicine services.
- Provider must be enrolled in Medicaid with specialty type 931 and list an in-state or qualifying bordering state practice address.
Maintain HIPAA-compliant technology and confidentiality protocols
Ensure telemedicine technology and site protocols meet HIPAA and confidentiality requirements, and implement authentication, encryption, and access controls as described by Medicaid.
- Use interactive audio or audio-and-video systems that permit two-way communication and are HIPAA-compliant.
- Implement confidentiality protocols (unique passwords, access tracking, authorized access lists) and make them available for inspection at the telemedicine site.
Submit Telemedicine Agreement, enroll as specialty 931, and meet origination site requirements
Providers must submit a Telemedicine Service Agreement/Certification to Medicaid's fiscal agent, enroll with specialty type 931, identify themselves with credentials at the time of service, and ensure origination sites meet HIPAA and confidentiality protocols.
- Submit Telemedicine Service Agreement/Certification (form available on Medicaid website).
- Enroll with Medicaid under specialty type 931 (Telemedicine Service).
- Identify provider name and credentials to the recipient at time of service.
- Ensure origination site technology is HIPAA-compliant and confidentiality protocols are implemented and available for inspection.
Document required telemedicine visit elements in the medical record
Document the telemedicine encounter fully in the medical record, including patient identification, parent/legal guardian if under age of consent, the patient’s physical location (city and state), provider identification and credentials, consent, condition treated, medical necessity, services rendered and level of medical decision making, 'in' and 'out' times, follow-up care, and other relevant visit details.
- Record patient identification and guardian attendance when applicable.
- Record patient physical location (city and state) at time of visit.
- Document provider identification/credentials and patient consent for telemedicine.
- Document services rendered, MDM to support billed code, in/out times, condition treated, medical necessity, and follow-up care.
Avoid billing excluded encounter types (chart reviews, email/fax, non‑HIPAA platforms)
Do not bill for or expect reimbursement for services that are chart reviews, electronic mail messages, facsimile transmissions, provider-to-provider consultations, or communications using non‑HIPAA‑compliant platforms such as Skype or FaceTime; such claims may be denied.
- Chart reviews, email, and fax communications are not eligible for reimbursement.
- Provider-to-provider consultations and services using non‑HIPAA‑compliant internet communications (e.g., Skype, FaceTime) are excluded and may trigger denial.
Do not submit claims for non‑reimbursable telemedicine services or unsupported provider/staff actions
Examples of telemedicine services not eligible for reimbursement include chart reviews, non‑HIPAA compliant internet communications (e.g., Skype, FaceTime), electronic mail between provider and recipient, facsimile transmissions, provider-to-provider consultations, services not provided by an enrolled provider or office staff, services not normally charged during an office visit, and services not listed in Provider Billing Manual chapters — billing these may result in claim denial.
- Non‑HIPAA consumer platforms and unsecured communications are not reimbursable.
- Services not directly provided by an enrolled provider or not listed in Provider Billing Manual chapters are excluded.
Key Definitions
Background and Scope
Telemedicine is the provision of medical services by a physician or other eligible provider to a patient at a distant site using synchronous (real-time audio or audio-and-video) or asynchronous communications technologies. Services delivered via telemedicine must permit appropriate evaluation, diagnosis, and treatment, be within the provider’s scope of license, and use technology that is HIPAA-compliant and sufficient to support clinical decision-making.
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