CurrentCareSourcePolicy N/A

Telemedicine Services - AR PASSE

This administrative policy governs CareSource reimbursement and coverage conditions for telemedicine (telehealth) services provided to Arkansas PASSE members, including payment parity with in-person services and requirements for originating/distant sites and documentation.

Policy Summary

PayerCareSource

PolicyTelemedicine Services - AR PASSE

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateJul 1, 2025

Next Review DateN/A

Key ActionSubmit approved HCPCS/CPT codes with appropriate modifiers and refer to the fee schedule for reimbursement.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

07/01/2025Effective date

Same reimbursementPayment parity

Facility fee availableOriginating site fee

Must be enrolledDistant site

ExcludedAudio-only

Telemedicine Coverage Criteria

Telemedicine coverage criteria

Covered when ALL of the following are met:

Service provided via telemedicine is comparable to the same service provided in person (payment parity).

Distant site professional or entity is an enrolled Arkansas Medicaid provider.

Originating site operated by a licensed or certified healthcare professional or entity that is authorized to bill Arkansas Medicaid may receive a reasonable facility fee; other originating sites are not eligible to bill a facility fee.

No facility fee is payable to the distant site.

Reimbursement requires submission of approved HCPCS and CPT codes with appropriate modifiers as applicable.

Policy Summary

PayerCareSource

PolicyTelemedicine Services - AR PASSE

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateJul 1, 2025

Next Review DateN/A

Key ActionSubmit approved HCPCS/CPT codes with appropriate modifiers and refer to the fee schedule for reimbursement.

SourceLink

On This Page

Billing, Enrollment, and Submission Requirements

Billing Rule

Provider enrollment and facility fee

Providers at the distant site must be enrolled as Arkansas Medicaid providers (distant-site enrollment required). Distant-site providers are not eligible to bill an originating-site facility fee. There is no facility fee for the distant site. A reasonable facility fee may be paid to the originating site only when the originating site is operated by a licensed or certified healthcare professional or entity that is authorized to bill Arkansas Medicaid directly for healthcare services.

Distant-site providers: must be an enrolled Arkansas Medicaid Provider
Originating-site facility fee: available only to originating sites authorized to bill Arkansas Medicaid directly
No facility fee: for the distant site

Billing Rule

Billing and submission requirements

Claims must include approved HCPCS and CPT codes and any applicable modifiers. Reimbursement is dependent on submission of these codes; providers should reference the individual fee schedule for appropriate codes. The modality of telemedicine/telehealth services must be documented in the medical record to support reimbursement.

Submit approved HCPCS/CPT codes with appropriate modifiers
Refer to the individual fee schedule for correct codes and reimbursement rates
Document telemedicine/telehealth modality in the medical record

Key Definitions

Distant Site — definition of the distant site location for the provider delivering services

DefinitionThe physical location of the healthcare professional delivering services through telemedicine at the time the services are provided.

Applies toDistant site refers to the provider’s physical location (not the member) during telemedicine encounters.

Enrollment implicationDistant-site providers must be enrolled Arkansas Medicaid providers to bill for telemedicine services.

Originating Site — definition of where the member is located when receiving telemedicine services

DefinitionThe physical location of a member at the time healthcare services are provided by means of telemedicine.

ExamplesIncludes the member’s home or any other location where the member is physically present when receiving telemedicine services.

Facility fee noteA reasonable facility fee may be paid to an originating site operated by a licensed or certified provider authorized to bill Arkansas Medicaid.

POS Code 02 — National Place of Service code for telehealth provided other than in member home

CodePOS Code 02

DefinitionNational Place of Service code for telehealth services provided other than in the member's home.

Use guidanceReport POS 02 when telehealth occurs at locations other than the member’s home (e.g., clinic, facility).

POS Code 10 — National Place of Service code for telehealth provided in member home

CodePOS Code 10

DefinitionNational Place of Service code for telehealth services provided in the member's home.

Use guidanceReport POS 10 when the member’s home is the originating site for the telehealth encounter.

Healthcare Professional — who qualifies as a healthcare professional under Arkansas law

DefinitionA person who is licensed, certified, or otherwise authorized by the laws of Arkansas to administer health care in the ordinary course of the practice of the profession.

ScopeIncludes physicians and other healthcare professionals who meet Arkansas licensure/certification requirements and are authorized to bill Arkansas Medicaid.

Reimbursement implicationCareSource reimburses licensed/certified professionals or entities authorized to bill Arkansas Medicaid on the same basis as in-person services.

Store-and-forward — definition of store-and-forward transmission of medical information

DefinitionTransmission of a member's medical information from a healthcare provider at an originating site to a healthcare provider at a distant site.

Included modalitiesStore-and-forward is an asynchronous telemedicine technology included in CareSource's telemedicine definition.

Originating site noteThe originating site may include the member’s home when using store-and-forward technology.

Remote patient monitoring — definition of remote client monitoring for treatment/management

DefinitionUse of electronic information and communication technology to collect personal health information and medical data from a member at an originating site that is transmitted to a healthcare provider at a distant site for use in the treatment and management of medical conditions that require frequent monitoring.

PurposeDesigned for treatment and management of medical conditions requiring frequent monitoring.

Included in telemedicineRemote patient monitoring is explicitly included in CareSource's telemedicine services definition and reimbursement framework.

Online Visit — definition of real-time two-way communication initiated by the member

DefinitionA real-time (synchronous) two-way communication initiated by the member to virtually connect a physician or other health care provider for low complexity health care services.

ModalitySynchronous audio/video interactions initiated by the member qualify as an Online Visit.

Coverage noteOnline visits are considered a telemedicine modality within the CareSource policy and subject to the same coverage criteria as other telemedicine services.

OpenPayer

Telemedicine Services - AR PASSE

Telemedicine Coverage Criteria

HCPCS / CPT Codes and Modifiers

Billing, Enrollment, and Submission Requirements

Key Definitions