CurrentCareSourcePolicy AR-PASSE-AD-1309

Telemedicine Services (Arkansas PASSE)

Defines CareSource PASSE reimbursement, coverage, and administrative rules for telemedicine/telehealth services delivered to Arkansas members and applicable to providers who bill Arkansas Medicaid directly.

Policy Summary

PayerCareSource

PolicyTelemedicine Services (Arkansas PASSE)

Policy CodePolicy AR-PASSE-AD-1309

Change TypeNon‑material revision

Effective DateJun 1, 2024

Next Review DateN/A

Key ActionSubmit approved HCPCS/CPT codes with appropriate modifiers and ensure the distant site provider is an enrolled Arkansas Medicaid provider.

SourceLink

POLICY UPDATE CHANGES

Updated references and committee approval noted with revision date 02/28/2024.

06/01/2024-06/30/2025effective range

Arkansasjurisdiction

POS 02 / POS 10POS codes

95modifier

Generally excludedaudio-only

Telemedicine Coverage Criteria

Telemedicine coverage criteria

Covered when ALL of the following are met:

Telemedicine services are delivered by licensed or certified healthcare professionals or entities authorized to bill Arkansas Medicaid directly.

Distant site provider is an enrolled Arkansas Medicaid provider.

Originating site may receive a reasonable facility fee only if the originating site is operated by a licensed or certified healthcare professional or entity authorized to bill Arkansas Medicaid directly; there is no facility fee for the distant site.

Appropriate billing and coding are submitted: approved HCPCS and CPT codes with applicable modifiers are required and reimbursement is subject to the individual fee schedule.

Policy Summary

PayerCareSource

PolicyTelemedicine Services (Arkansas PASSE)

Policy CodePolicy AR-PASSE-AD-1309

Change TypeNon‑material revision

Effective DateJun 1, 2024

Next Review DateN/A

Key ActionSubmit approved HCPCS/CPT codes with appropriate modifiers and ensure the distant site provider is an enrolled Arkansas Medicaid provider.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Place of Service, Modifiers, and Documentation

Place of Service Codesmixed

POS 02	Telehealth services provided other than in member home
POS 10	Telehealth services provided in member home

Telemedicine ModifierModifier

Modifier 95

Synchronous telemedicine services via real-time audio and video telecommunications system

Documentation requirement — modality

RequirementModality of telemedicine/telehealth services must be documented in the medical record to be reimbursed.

Documentation scopeMedical record must include modality (e.g., synchronous audio/video, store-and-forward, remote monitoring) for each telemedicine encounter.

Audio-only specificsFor audio-only engagements, documentation must address the problem, conversation content, medical decision-making, and plan of care.

AuditabilityMedical documentation for telemedicine is subject to the same audit and review processes as in-person visits.

Billing, Enrollment, and Provider Requirements

Billing Rule

Billing and Enrollment Requirements

Providers must follow specific billing and enrollment requirements to receive reimbursement for telemedicine/telehealth services. Ensure submission of approved HCPCS and CPT codes with appropriate modifiers, document the telemedicine modality in the medical record, and confirm the distant-site professional or entity is an enrolled Arkansas Medicaid provider. Facility fees may be payable to an originating site only when that site is a licensed or certified healthcare professional or entity authorized to bill Arkansas Medicaid directly.

Submit approved HCPCS/CPT codes and appropriate modifiers as required; refer to the individual fee schedule for correct codes.
Document telemedicine modality (video, audio-only, store-and-forward as applicable) in the medical record.
Distant-site providers must be enrolled Arkansas Medicaid providers to bill; non-enrolled originating sites are not eligible to bill a facility fee.
A reasonable facility fee may be paid to an originating site operated by a licensed/certified healthcare professional or entity only if authorized to bill Arkansas Medicaid directly.
Ensure a documented professional relationship exists before providing telemedicine services (e.g., prior in-person exam, ongoing relationship, or formal consult/referral with supervision agreed).
CareSource PASSE reimburses telemedicine services comparable to the same in-person service; no facility fee for the distant site.

Key Definitions

Distant Site (provider location)

DefinitionDistant Site: The physical location of the healthcare professional delivering services through telemedicine at the time the services are provided.

Enrollment noteDistant site providers must be licensed/certified and authorized to bill Arkansas Medicaid directly to be reimbursed.

RoleDelivers assessment, diagnosis, consultation, treatment, education, care management, and self-management via telemedicine technologies.

Originating Site (member location)

DefinitionOriginating Site: The physical location of a member at the time healthcare services are provided by means of telemedicine.

ExamplesIncludes the member's home when store-and-forward or remote monitoring originates from that location.

Facility feeA reasonable facility fee may be paid to the originating site if the site is authorized to bill Arkansas Medicaid directly.

POS 02 / POS 10

POS 02National Place of Service (POS) Code 02: Telehealth services provided other than in member home.

POS 10National Place of Service (POS) Code 10: Telehealth services provided in member home.

Use guidanceApply appropriate POS code when submitting approved HCPCS/CPT codes; refer to individual fee schedule for codes and billing rules.

Modifier 95

DefinitionModifier 95: Synchronous telemedicine services via real-time audio and video telecommunications system.

Billing useAppend Modifier 95 to approved CPT/HCPCS codes for synchronous audio-video telemedicine encounters when submitting claims.

Documentation tie-inClaims with Modifier 95 must be supported by medical record documentation of the telemedicine modality and encounter details.

Online Visit

DefinitionOnline Visit: A 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.

ScopeIntended for member-initiated, low-complexity issues conducted via synchronous communication.

ExclusionsNon-covered modalities include internet questionnaires, email, text messaging, fax, and client-generated histories that do not meet synchronous interaction criteria.