Alaska

Last updated 11/22/2024

Consent

What type of informed consent is required when providing services via telehealth?

Alaska Medicaid requires providers to obtain consent for delivering services through a telehealth modality prior to services being rendered. Receipt of consent must be documented in the member’s file and may be obtained for a period of time agreed upon between the member/member representative and provider or may be for a single visit. Both written and verbal consent is acceptable for the purposes of telehealth.

• Verbal Consent: Consent may be obtained verbally in most scenarios. The patient’s clinical record must confirm that the member consented to a telehealth mode of delivery.
• Written Consent: Some services, regardless of the mode of delivery, may require written consent. Providers should refer to their scope of practice requirements for any written consent requirements.

SOURCE: Alaska Medicaid Frequently Asked Questions Coverage of Telehealth Modalities, Sept. 19, 2023, (Accessed Nov. 2024).

Last updated 11/22/2024

Definitions

“Telehealth” means the practice of health care delivery, evaluation, diagnosis, consultation, or treatment using the transfer of medical data, audio, visual, or data communications at two or more locations between a provider and recipient who are physically separated from each other.

SOURCE: AK Admin Code 7 AAC 110.639, (Accessed Nov. 2024).

“Telehealth” means the practice of health care delivery, evaluation, diagnosis, consultation, or treatment, using the transfer of health care data through audio, visual, or data communications, performed over two or more locations between providers who are physically separated from the recipient or from each other or between a provider and a recipient who are physically separated from each other.

SOURCE: AK Statute Sec. 47.05.270(e), (Accessed Nov. 2024).

“Alaska Medicaid will pay for telemedicine services delivered in the following manner:

• Interactive method: Provider and patient interact in ‘real-time’ using video/camera and/or dedicated audio conference equipment.
• Store-and-forward method: The provider sends digital images, sounds, or previously recorded video to a consulting provider at a different location. The consulting provider reviews the information and reports back his or her analysis.
• Self-monitoring method: The patient is monitored in his or her home via a telemedicine application, with the provider indirectly involved from another location.”

Note: Manual is under review.

SOURCE: State of AK Dept. of Health and Social Svcs., Alaska Medical Assistance Provider Billing Manuals for Physician Services, p. 31 (5/2013), (Accessed Nov. 2024).

Telemedicine means the practice of health care delivery, evaluation, diagnosis, consultation, or treatment, using the transfer of medical data through audio, video [visual], or data communications that are engaged in over two or more locations between providers who are physically separated from the patient or from each other.

SOURCE: AK Admin. Code, Title 7, 12.449; 12.490;  86.090, (Accessed Nov. 2024).

Last updated 11/22/2024

Email, Phone & Fax

Procedure Code Modifier:

• Two-Way Audio-Video Technology: GT or 95
• Store-and-Forward: GQ
• Two-Way Audio Only Technology : FQ and 93

Procedure Codes Defined as Audio Only: Failure to include either modifier FQ or modifier 93 will result in denial of payment for audio only services.

Patient Initiated Online Digital Services: Do not use telehealth modifiers when billing CPT codes 98970 – 98972 and 99421 – 99423.

Telehealth for Acute Stroke: Use procedure code modifier G0 (G-Zero) and the appropriate telehealth modifier (GT, 95, GQ, or FQ).

Helpful Hint: Modifier G0 (G-Zero) often gets confused with GO (G-Oh). Please ensure the appropriate modifier is utilized when billing either G0 (G-Zero) or GO (G-Oh).

If my business limits telehealth to two-way audio only and online digital services, do I need to register my business on the Telehealth Registry?

Yes: Two-way audio only and online digital services are considered forms of telehealth and require your business to be on the telehealth registry.

Does Medicaid cover patient-initiated telephone services?

Yes: Medicaid covers patient-initiated telephone services for established patients. Refer to the Telehealth Services Temporary Fee Schedule, for more information on who can be reimbursed for these services.

What is a patient-initiated telephone service?

Patient-initiated telephone service CPT codes are meant to be used when an evaluation, management, or assessment is done over the phone with a patient who has contacted the provider for a healthcare related reason.

• Separately Reimbursable Communications: Patient-initiated telephone-based communication for evaluation, management, or assessment of a patient who has reported a healthcare problem. Documentation must include the healthcare discussion that occurred, and the evaluation, management, or assessment provided.
• Non-Covered Communications: Patient-initiated telephone-based communication for healthcare reasons that do not involve an evaluation, management, or assessment of the patient and administrative functions such as updating the patient’s insurance, scheduling, and appointments.
• Provider Initiated Communications: Providers are not prohibited from initiating telephone-based communication, but these functions are not reimbursable services.

What provider types are authorized to bill for patient-initiated telephone services?

CPT Codes 98966-98968: Covered for behavioral health aides under the direction of a physician, psychologists, and school districts enrolled as a school-based services provider. Federally Qualified Health Centers and Rural Health Centers may be reimbursed at their encounter rate for services provided by licensed clinical social workers, marital and family therapists, professional counselors, and psychologists.

CPT Codes 99441-99443: Covered for advanced practice registered nurses, audiologists, Community Health Aides, direct entry midwives, optometrists, physicians, physician assistants, and podiatrists. Federally Qualified Health Centers and Rural Health Clinic may be reimbursed at the facility’s encounter rate for services provided by a rendering providers listed here.

When are patient-initiated telephone services separately reimbursable?

Two-Way Audio Only services that are patient-initiated are separately reimbursable when billed using CPT codes 98966-98968 or 99441-99443. Per AMA coding guidelines, patient-initiated telephone services are separately reimbursable if the communication meets all of the below criteria:

Established Patient: Member is an established patient

Evaluative in Nature: Service is to evaluate, assess, or manage the member’s health

Patient-Initiated: Call must be patient initiated without prompting

No other Affiliated Service: Not separately reimbursable if affiliated to another evaluation and management service, assessment, or procedure. The online digital service is not reimbursable if the communication:

• leads to another in-person or telehealth (asynchronous or synchronous) visit related to the illness, injury, or other reason within 24 hours or soonest available,
• is related to an in-person or telehealth (asynchronous or synchronous) during the previous 7 days, or
• is related to a surgery or procedure occurring within the post-operative or global period.

Is there a limit to how many patient-initiated telephone services may be reimbursed?

Yes: Alaska Medicaid will reimburse up to 1 patient-initiated telephone service per day, per member.

SOURCE: Alaska Medicaid Frequently Asked Questions Coverage of Telehealth Modalities, Sept. 19, 2023, (Accessed Nov. 2024).

The department shall pay for all services covered by the medical assistance program provided through telehealth in the same manner as if the services had been provided in person, including …

• Services provided through audio, visual, or data communications, alone or in any combination, or through communications over the Internet or by telephone, including a telephone that is not part of a dedicated audio conference system, electronic mail, text message, or two-way radio

SOURCE: AK Statute Sec. 47.07.069, (Accessed Nov. 2024).

Alaska Medicaid will not pay for

• The use of telemedicine equipment and systems
• Services delivered by telephone when not part of a dedicated audio conference system
• Services delivered by facsimile

Note: Manual is under review.

SOURCE: State of AK Dept. of Health and Social Svcs., Alaska Medical Assistance Provider Billing Manuals for Physician, ARNP, PA Services (5/13), p. 31, (Accessed Nov. 2024).

Subject to the requirements of 7 AAC 110.620 – 7 AAC 110.639, the department will pay for a service delivered by means of one of the following telehealth modalities if the modality and use of the modality meet the requirements of P.L. 104 – 191 (Health Insurance Portability and Accountability Act of 1996 (HIPAA)):

• synchronous: live or interactive, through a real-time, interactive …
  • two-way audio-only technology that allows for oral communication between the provider and the recipient

SOURCE: AK Admin Code, Title 7, 625 (Accessed Nov. 2024).

Tribal FQHC

Will my facility be able to continue to provide telemedicine (video-audio synchronous) and telephonic (audio-only) behavioral health services as a Tribal FQHC?

Refer to the most current guidance document on telehealth: https://extranetsp.dhss.alaska.gov/hcs/medicaidalaska/Provider/Updates/20230919_Telehealth_FAQs.pdf.

Telehealth Services. Will my facility be able to provide telemedicine (video-audio synchronous), telephonic (audio-only), and store and forward telehealth services and be reimbursed for those services as a Tribal FQHC?

Yes, telehealth services regulations were effective 9/1/2023. Refer to the most current guidance on telehealth services: https://extranetsp.dhss.alaska.gov/hcs/medicaidalaska/Provider/Sites/Telehealth.html

SOURCE:  Alaska Medicaid, FAQs on Tribal FQHCs, (Accessed Nov. 2024).

Last updated 11/22/2024

Live Video

POLICY

The department shall pay for all services covered by the medical assistance program provided through telehealth if the same manner as if the services had been provided in person (see Eligible Services Section below for eligible services).

The department shall adopt regulations for services provided by telehealth, including setting rates of payment. Regulations calculating the rate of payment for a rural health clinic or federally qualified health center must treat services provided through telehealth in the same manner as if the services had been provided in person, including calculations based on the rural health clinic’s or federally qualified health center’s reasonable costs or on the number of visits for recipients provided services, and must define “visit” to include a visit provided by telehealth. The department may not decrease the rate of payment for a telehealth service based on the location of the person providing the service, the location of the eligible recipient of the service, the communication method used, or whether the service was provided asynchronously or synchronously. The department may exclude or limit coverage or reimbursement for a service provided by telehealth, or limit the telehealth modes that may be used for a particular service, only if the department

1. specifically excludes or limits the service from telehealth coverage or reimbursement by regulations adopted under this subsection;
2. determines, based on substantial medical evidence, that the service cannot be safely provided using telehealth or using the specified mode; or
3. determines that providing the service using the specified mode would violate federal law or render the service ineligible for federal financial participation under applicable federal law.

All services delivered through telehealth under this section must comply with the Health Insurance Portability and Accountability Act of 1996 (P.L. 104-191).

SOURCE: AK Statute Sec. 47.07.069, (Accessed Nov. 2024).

Subject to the requirements of 7 AAC 110.620 – 7 AAC 110.639, the department will pay for a service delivered by means of one of the following telehealth modalities if the modality and use of the modality meet the requirements of P.L. 104 – 191 (Health Insurance Portability and Accountability Act of 1996 (HIPAA)):

• synchronous: live or interactive, through a real-time, interactive
  • two-way audio-video technology that includes, at a minimum, an operational camera, microphone, speaker or headphones, and capability to view video feed;
  • two-way audio-only technology that allows for oral communication between the provider and the recipient;

SOURCE: AK Admin. Code, Title 7, 110.625. (Accessed Nov. 2023).

Alaska Medicaid will pay for a covered medical service furnished through telemedicine application if the service is:

• Covered under traditional, non-telemedicine methods;
• Provided by a treating, consulting, presenting or referring provider;
• Appropriate for provision via telemedicine

Note: Manual is under review.

Source: State of AK Dept. of Health and Social Svcs, Alaska Medical Assistance Provider Billing Manuals for Physician, PA, ARNP Services (5/13), p. 31, (Accessed Nov. 2024).

On July 13th, 2023, the Department of Health (DOH) adopted revised regulations for Medicaid coverage and payment for healthcare services provided through telehealth. These regulations went into effect September 1st, 2023. The department is in process of amending current telehealth guidance and updating system rules to accommodate these changes. This document is intended to answer common questions regarding Alaska Medicaid coverage and reimbursement of services provided through a telehealth modality as of September 1st, 2023.

What are the covered modalities for telehealth services?

Synchronous through a real-time, interactive:

• Two-Way Audio-Video Technology: Includes, at minimum, an operational camera, microphone, speaker or headset, and capability to view video feed, or
• Two-Way Audio Only Technology: Includes an operational microphone and speaker or headphones.

Asynchronous:

• Store-and-Forward: The transfer between healthcare providers of recorded digital images, video, or sounds from one location to another.

Patient-Initiated Online Digital Services:

• Synchronous or asynchronous: Evaluation, assessment, and management services of an established patient through a secure platform such as an electronic record portal, secure electronic mail, or digital application.

SOURCE: Alaska Medicaid Frequently Asked Questions Coverage of Telehealth Modalities, Sept. 19, 2023), (Accessed Nov. 2024).

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ELIGIBLE SERVICES/SPECIALTIES

Subject to the requirements of 7 AAC 110.620 – 7 AAC 110.639, the department will pay for a service delivered by means of a telehealth modality if the service

• Would be covered under 7 AAC 105 – 7 AAC 160 if delivered in person; and
• Is delivered in compliance with
  • The same requirements of 7 AAC 105 – 7 AAC 160, including prior authorization requirements and service limitations, as if the service was delivered in person; and
  • The requirements of AS 08.01, AS 08.68, AS 47.07, and 7 AAC 105 – 7 AAC 160, including the telehealth requirements and limitations of 7 AAC 110.620 – 7 AAC 110.639, as applicable to the service, the provider, and the mode of delivery.

SOURCE: AK Admin. Code, Title 7, 110.620. (Accessed Nov. 2024).

1. behavioral health services;
2. services covered under home and community-based waivers;
3. services covered under state plan options under 42 U.S.C. 1396-1396p (Title XIX, Social Security Act);
4. services provided by a community health aide or a community health practitioner certified by the Community Health Aide Program Certification Board;
5. services provided by a behavioral health aide or behavioral health practitioner certified by the Community Health Aide Program Certification Board;
6. services provided by a dental health aide therapist certified by the Community Health Aide Program Certification Board;
7. services provided by a chemical dependency counselor certified by a certifying entity for behavioral health professionals in the state specified by the department in regulation;
8. services provided by a rural health clinic or a federally qualified health center;
9. services provided by an individual or entity that is required by statute or regulation to be licensed or certified by the department or that is eligible to receive payments, in whole or in part, from the department;
10. services provided through audio, visual, or data communications, alone or in any combination, or through communications over the Internet or by telephone, including a telephone that is not part of a dedicated audio conference system, electronic mail, text message, or two-way radio;
11. assessment, evaluation, consultation, planning, diagnosis, treatment, case management, and the prescription, dispensing, and administration of medications, including controlled substances; and
12. services covered under federal waivers or demonstrations other than home and community-based waivers.

The department shall adopt regulations for services provided by telehealth, including setting rates of payment. Regulations calculating the rate of payment for a rural health clinic or federally qualified health center must treat services provided through telehealth in the same manner as if the services had been provided in person, including calculations based on the rural health clinic’s or federally qualified health center’s reasonable costs or on the number of visits for recipients provided services, and must define “visit” to include a visit provided by telehealth. The department may not decrease the rate of payment for a telehealth service based on the location of the person providing the service, the location of the eligible recipient of the service, the communication method used, or whether the service was provided asynchronously or synchronously. The department may exclude or limit coverage or reimbursement for a service provided by telehealth, or limit the telehealth modes that may be used for a particular service, only if the department

1. specifically excludes or limits the service from telehealth coverage or reimbursement by regulations adopted under this subsection;
2. determines, based on substantial medical evidence, that the service cannot be safely provided using telehealth or using the specified mode; or
3. determines that providing the service using the specified mode would violate federal law or render the service ineligible for federal financial participation under applicable federal law.

All services delivered through telehealth under this section must comply with the Health Insurance Portability and Accountability Act of 1996 (P.L. 104-191).

SOURCE: AK Statute Sec. 47.07.069, (Accessed Nov. 2024).

See list of telehealth services allowed in Alaska Medicaid’ temporary telehealth services fee schedule for FY 2024.

SOURCE: Alaska Medicaid, Telehealth Services: Temporary Fee Schedule, Effective 9/1/2023, (Accessed Nov. 2024).

Check behavioral health fee schedules and Section 1115 Medicaid Waiver Services Administrative Manuals for services allowed via telehealth.

SOURCE: Medicaid Provider Assistance Information, Division of Behavioral health, Fee Schedules [fee schedules listed at bottom of page], (Accessed Nov. 2024).

Eligible services:

• An initial visit
• One follow-up visit;
• A consultation to confirm a diagnosis;
• Diagnostic, therapeutic or interpretive service;
• A psychiatric or substance abuse assessments;
• Psychotherapy
• Pharmacological management services on an individual recipient basis.

Note: Manual is under review.

SOURCE: State of AK Dept. of Health and Social Svcs., Alaska Medical Assistance Provider Billing Manuals for Physician, ARNP, PA Services (5/13), p. 31, (Accessed Nov. 2024).

Dental services do not require the use of the telemedicine modifier.

Note: Manual is under review.

SOURCE: AK Dept. of Health and Social Svcs.  Tribal Services Manual (1/3/17), pg. 97, (Accessed Nov. 2024).

For patient-initiated online digital service, whether synchronous or asynchronous, the following are not reimbursable:

• Nonevaluative or nonmanagement services including appointment scheduling and electronic communication of test results;
• Provider-initiated online digital service;
• Patient-initiated online digital service within the postoperative period of a completed procedure or within seven days of an in-person visit and related to the illness, injury, or other reason for that visit.

The department will not pay

• for the use, or any costs associated with the use, of technological equipment and systems associated with the delivery of a service by means of a telehealth modality;
• a provider for communication with that provider’s supervising provider or communication with a provider who is acting in a supervisory capacity;
• a supervising provider or a provider who is acting in a supervisory capacity for communication with a supervisee or for review of a supervisee’s work;
• a provider participating in a telehealth encounter whose sole purpose is to facilitate the telehealth encounter between the recipient and a rendering provider or a consulting provider;
• for a failed or unsuccessful telehealth connection or transmission;
• for the following services when provided by means of a telehealth modality::
  • chiropractic services;
  • dental services;
  • private-duty nursing services;
  • pharmacy dispensing services;
  • durable medical equipment and related services;
  • prosthetic and orthotic devices and related services;
  • transportation services;
  • accommodation services;
  • personal care services;
  • home health services;
  • community First Choice services;
  • home and community-based waiver services, except for
    • care coordination services under 7 AAC 130.240;
    • day habilitation services under 7 AAC 130.260;
    • employment services under 7 AAC 130.270; or
    • intensive active treatment services under 7 AAC 130.275;

SOURCE:  AK Admin. Code, Title 7, 110. 625 & 635 (Accessed Nov. 2024).

Alaska Medicaid will not pay for

• The use of telemedicine equipment and systems
• Services delivered by telephone when not part of a dedicated audio conference system
• Services delivered by facsimile
• The following services provided by telemedicine application:
  • Direct entry midwife
  • Durable medical equipment (DME)
  • End-stage renal disease
  • Home and community-based waiver
  • Personal care assistant
  • Pharmacy
  • Private duty nursing
  • Transportation and accommodation
  • Vision (includes visual care, dispensing, or optician services)

Note: Manual under review.

SOURCE: State of AK Dept. of Health and Social Svcs., Alaska Medical Assistance Provider Billing Manuals for Physician, ARNP and PA Services (5/13), pg. 31-32 (Nov. 2024).

The department will pay in accordance with 7 AAC 145.020 for a service delivered by means of a telehealth modality by a rendering provider or a consulting provider in accordance with 7 AAC 110.620 – 7 AAC 110.639 as set out under 7 AAC 145.020.

The department will pay a rendering provider or a consulting provider in the same manner as payment is made for the same service provided through in-person mode of delivery, not to exceed 100 percent of the rate established under 7 AAC 145.050.

SOURCE: AK Admin Code, Title 7, 145.270, (Accessed Nov. 2024).

The department will not pay a physician for experimental therapy, nonmedical outpatient therapy, or nonmedical counseling, including any of the following services:

• interaction between recipient and provider by means of the Internet, except as provided in 7 AAC 110.620 — 7 AAC 110.639 for telehealth services.

SOURCE: Alaska Admin Code, Title 7, 110.445, (Accessed Nov. 2024).

Non-Emergency Medical Transportation and Escort Coverage

Clarifies types of services feasible for telehealth throughout the document.

SOURCE: Alaska Medicaid Policy Clarification Non-Emergency Medical Transportation, Sept. 18, 2023 (revised 11/29/23), (Accessed Nov. 2024).

Does Alaska Medicaid cover problem focused exams delivered through a telehealth modality?

Patient Initiated: Yes, service may be covered under CPT code 99441-99443.

Scheduled Visit or Provider Initiated: Yes, Problem focused evaluation and management services (CPT 99202-99205 and 99211-99215) are covered when delivered through Two-Way Audio-Video Technology or through store-and-forward.

Are therapy services (PT, OT, SLP) covered when delivered through a telehealth modality?

Yes: Therapy services (PT, OT, SLP) are covered when delivered through Two-Way Audio-Video Technology if the service is identified on the Telehealth Services Temporary Fee Schedule.

Use the same procedure codes as you would for an in-person encounter and apply a procedure modifier of either GT or 95.

Are initial hospital services reimbursable if performed via telehealth?

Yes: The professional component may be reimbursed using CPT codes 99221-99223 when services are delivered through Two-Way Audio-Video Technology.

Are initial nursing facility care services reimbursable if performed via telehealth?

Yes: The professional component may be reimbursed using CPT codes 99304-99306 when services are delivered through Two-Way Audio-Video Technology.

Can ventilator management services be conducted via a telehealth mode of delivery?

Yes: Ventilator management is reimbursable when performed via telehealth. Only the healthcare provider managing the ventilator may be reimbursed for ventilator management; any bedside adjustments are not separately reimbursable.

SOURCE: Alaska Medicaid Frequently Asked Questions Coverage of Telehealth Modalities, Sept. 19, 2023, (Accessed Nov. 2024).

DME Oxygen Guidelines and Concerns

Telehealth is included of definition of face-to-face encounter between the treating practitioner and the beneficiary and the encounter must be used for the purpose of gathering subjective and objective information associated with diagnosing, treating, or managing a clinical condition for which the DMEPOS is ordered.

SOURCE: Alaska Dep. of Health, Letter to DME Providers, RE Review of Oxygen Guidelines and Concerns, Dec. 29, 2023, (Accessed Nov. 2024).

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ELIGIBLE PROVIDERS

Subject to the requirements of 7 AAC 110.620 – 7 AAC 110.639, to be eligible for payment under 7 AAC 105 – 7 AAC 160 for providing a service by means of a telehealth modality, a provider must meet the following requirements:

• the provider must have an active license under AS 08 or AS 47, an active certification in the state, or an active license under the applicable laws of the jurisdiction in which the provider is located;
• the provider must be enrolled under 7 AAC 105.210;
• the provider, if licensed under AS 08 and required under 12 AAC 02.600, must be registered under 12 AAC 02.600 (telemedicine business registry);
• the service must be delivered within the rendering provider’s, and if applicable, consulting provider’s scope of licensure or certification;
• a claim submitted to the department must include applicable telehealth modifiers and place-of-service coding;
• if the rendering provider or consulting provider determines, during a telehealth encounter, that a service extends beyond the scope of that provider’s license or certification, the provider must discontinue the encounter and refer the recipient to an appropriate provider; the rendering provider or consulting provider may bill only for the portion of the encounter that was within that provider’s scope of license or certification and only if the rendered portion of the encounter met all criteria of a separately billable service;
• except as otherwise provided in 7 AAC 105 – 7 AAC 160, a recipient must be present during and participate in a telehealth encounter;
• the provider must comply with all record keeping requirements set out under 7 AAC 105.230 for all telehealth services rendered;
• the rendering provider and consulting provider, when delivering a service by means of a synchronous telehealth modality, must annotate the patient’s clinical record with the method of delivery, the recipient’s location during the delivery of the service, and confirmation that the recipient has consented to a telehealth method of delivery.

SOURCE:  AK Admin. Code, Title 7, 110. 630 (Accessed Nov. 2024).

How do I bill for a services when a telehealth modality was used?

Procedure Code Modifier:

• Two-Way Audio-Video Technology: GT or 95
• Store-and-Forward: GQ
• Two-Way Audio Only Technology : FQ and 93

Procedure Codes Defined as Audio Only: Failure to include either modifier FQ or modifier 93 will result in denial of payment for audio only services.

Patient Initiated Online Digital Services: Do not use telehealth modifiers when billing CPT codes 98970 – 98972 and 99421 – 99423.

Telehealth for Acute Stroke: Use procedure code modifier G0 (G-Zero) and the appropriate telehealth modifier (GT, 95, GQ, or FQ).

Helpful Hint: Modifier G0 (G-Zero) often gets confused with GO (G-Oh). Please ensure the appropriate modifier is utilized when billing either G0 (G-Zero) or GO (G-Oh).

Are services provided by therapy assistants covered when provided via a telehealth modality?

Yes: Services provided by enrolled physical and occupational therapy assistant and speech language pathology assistant are covered to the same extent as the supervising therapist.

Are outpatient rehabilitation Hospitals able to bill telehealth for therapy services (OT, PT, SLP) using a UB-04 or 837I and are there any additional requirements for identifying the claim as a telehealth claim?

Yes: Therapy services provided in an outpatient rehabilitation hospital setting are covered when delivered through Two-Way Audio-Video Technology for services identified on the Telehealth Services Temporary Fee Schedule.

Additional Requirements: Effective for dates of service on and after 7/1/2023, claims submitted with therapy revenue codes 042X, 043X, and 044X will require an appropriate CPT/HCPCS procedure code in form locater 44, HCPCS/Accommodation Rates/HIPPS Rate Codes.

Can direct entry midwives provide telehealth services?

Yes: Effective 9/1/2023 services provided by direct entry midwives are covered if identified on the Telehealth Services Temporary Fee Schedule.

Can optometrists provide telehealth services?

Yes: Effective 9/1/2023 services provided by optometrists are covered if identified on the Telehealth Services Temporary Fee Schedule.

Do I need to register with the Telemedicine Business Registry to offer telehealth services?

Yes, in most cases: All businesses engaged in or planning to engage in distance delivery of health care to a patient located in Alaska must register with the state’s Telemedicine Business Registry. Providers who are an employee of a business do not need to register.

Providers subject to Telemedicine Business Registry requirements:

Alaska-licensed audiologist or speech-language pathologist; behavior analyst; chiropractor; professional counselor; dentist or dental hygienist; dietitian or nutritionist; naturopath; marital and family therapist; physician, podiatrist, osteopath, or physician assistant; direct-entry midwife; nurse or advanced practice registered nurse (APRN); dispensing optician; optometrist; pharmacist; physical therapist or occupational therapist; psychologist or psychological associate; social worker; or a physician licensed in another state.
* This information is based off of May 22nd, 2023, DCCED publication. See DCCED’s Telehealth Information Webpage for updates.

SOURCE: Alaska Medicaid Frequently Asked Questions Coverage of Telehealth Modalities, Sept. 19, 2023, (Accessed Nov. 2024).

The department shall pay for all services covered by the medical assistance program provided through telehealth if the department pays for those services when provided in person, including:

…

1. services provided by a community health aide or a community health practitioner certified by the Community Health Aide Program Certification Board;
2. services provided by a behavioral health aide or behavioral health practitioner certified by the Community Health Aide Program Certification Board;
3. services provided by a dental health aide therapist certified by the Community Health Aide Program Certification Board;
4. services provided by a chemical dependency counselor certified by a certifying entity for behavioral health professionals in the state specified by the department in regulation;
5. services provided by a rural health clinic or a federally qualified health center;
6. services provided by an individual or entity that is required by statute or regulation to be licensed or certified by the department or that is eligible to receive payments, in whole or in part, from the department;

SOURCE: AK Statute Sec. 47.07.069, (Accessed Nov. 2024).

The role of the provider falls into three categories:

1. Referring Provider: Evaluates a patient, determines the need for a consultation, and arranges services of a consulting provider for the purpose of diagnosis and treatment.
2. Presenting Provider: Introduces a patient to the consulting provider during an interactive telemedicine session (may assist in the telemedicine consultation).
3. Consulting Provider: Evaluates the patient and/or medical data/images using telemedicine mode of delivery upon recommendation of the referring provider.

NOTE: Manual is under review.

SOURCE: AK Dept. of Health and Social Svcs. Billing for Telemedicine Services. Section II: Professional Claims Management, Feb. 6, 2020 (section revised 6/12), pg. 20, (Accessed Nov. 2024).

Mental Health

An entity designated by the department under AS 47.30.520 — 47.30.620 may provide community mental health services authorized under AS 47.30.520 — 47.30.620 through telehealth to a patient in this state.

If an individual employed by an entity designated by the department under AS 47.30.520 — 47.30.620, in the course of a telehealth encounter with a patient, determines that some or all of the encounter will extend beyond the community mental health services authorized under AS 47.30.520 — 47.30.620, the individual shall advise the patient that the entity is not authorized to provide some or all of the services to the patient, recommend that the patient contact an appropriate provider for the services the entity is not authorized to provide, and limit the encounter to only those services the entity is authorized to provide. The entity may not charge a patient for any portion of an encounter that extends beyond the community mental health services authorized under AS 47.30.520 — 47.30.620.

A fee for a service provided through telehealth under this section must be reasonable and consistent with the ordinary fee typically charged for that service and may not exceed the fee typically charged for that service.

An entity permitted to provide telehealth under this section may not be required to document a barrier to an in-person visit to provide health care services through telehealth. The department may not limit the physical setting from which an entity may provide health care services through telehealth.

Nothing in this section requires the use of telehealth when an individual employed by an entity designated by the department under AS 47.30.520 — 47.30.620 determines that providing services through telehealth is not appropriate or when a patient chooses not to receive services through telehealth.

SOURCE: AK Statute Sec. 47.30.585, (Accessed Nov. 2024).

Uniform Alcoholism and Intoxication Treatment

A public or private treatment facility approved under AS 47.37.140 may provide health care services authorized under AS 47.37.030 — 47.37.270 through telehealth to a patient in this state.

If an individual employed by a public or private treatment facility approved under AS 47.37.140, in the course of a telehealth encounter with a patient, determines that some or all of the encounter will extend beyond the health care services authorized under AS 47.37.030 — 47.37.270, the individual shall advise the patient that the facility is not authorized to provide some or all of the services to the patient, recommend that the patient contact an appropriate provider for the services the facility is not authorized to provide, and limit the encounter to only those services the facility is authorized to provide. The facility may not charge a patient for any portion of an encounter that extends beyond the health care services authorized under AS 47.37.030 — 47.37.270.

A fee for a service provided through telehealth under this section must be reasonable and consistent with the ordinary fee typically charged for that service and may not exceed the fee typically charged for that service.

A facility permitted to practice telehealth under this section may not be required to document a barrier to an in-person visit to provide health care services through telehealth. The department may not limit the physical setting from which a facility may provide health care services through telehealth.

Nothing in this section requires the use of telehealth when an individual employed by a facility approved under AS 47.37.140 determines that providing services through telehealth is not appropriate or when a patient chooses not to receive services through telehealth.

SOURCE: AK Statute Sec. 47.37.145, (Accessed Nov. 2024).

Various services are allowed via telehealth for Alaska Behavioral Health and Substance Use Disorder (SUD) Providers.  See manuals.

SOURCE: State of Alaska Department of Health and Social Services Division of Behavioral Health Services, Alaska Behavioral Health Providers Services Standards & Administrative Procedures for Behavioral Health Provider Services & SUD Services [see both documents], (Accessed Nov. 2024).

Stand-alone vaccine counseling may be covered when provided via telehealth if the appropriate telehealth modifier and place of service are reported on the claim.

Stand-alone vaccine counselling, rendered in person or telehealth, is not separately reimbursable if the vaccine associated with the counselling is administered within one month of counseling.

SOURCE:  Alaska Medicaid Provider Billing Manual, Immunization Services, pg. 12, (Accessed Nov. 2024).

Tribal FQHC

Will my facility be able to continue to provide telemedicine (video-audio synchronous) and telephonic (audio-only) behavioral health services as a Tribal FQHC?

Refer to the most current guidance document on telehealth: https://extranetsp.dhss.alaska.gov/hcs/medicaidalaska/Provider/Updates/20230919_Telehealth_FAQs.pdf.

Telehealth Services. Will my facility be able to provide telemedicine (video-audio synchronous), telephonic (audio-only), and store and forward telehealth services and be reimbursed for those services as a Tribal FQHC?

Yes, telehealth services regulations were effective 9/1/2023. Refer to the most current guidance on telehealth services: https://extranetsp.dhss.alaska.gov/hcs/medicaidalaska/Provider/Sites/Telehealth.html

Can a Tribal FQHC provide services off-site after February 11, 2025?

Yes, please refer to telehealth regulations that were effective 9/1/2023 https://aws.state.ak.us/OnlinePublicNotices/Notices/Attachment.aspx?id=142671

SOURCE:  Alaska Medicaid, FAQs on Tribal FQHCs, (Accessed Nov. 2024).

This manual includes information about Alaska Medical Assistance for the following types of providers and services:

• Telemedicine

Dental telemedicine services do not require use of the telemedicine modifier.

SOURCE: State of Alaska Department of Health and Social Services Division, Alaska Medical Assistance Provider Billing Manual, Tribal Facility Services, Policies and Procedures, Feb. 18, 2021, (Accessed Nov. 2024).

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ELIGIBLE SITES

How do I bill for a services when a telehealth modality was used?

Place of Service Code:

• Place of Service Code 02: Telehealth- member not located at home during encounter
• Place of Service Code 10: Telehealth – member is located at home during encounter

SOURCE: Alaska Medicaid Frequently Asked Questions Coverage of Telehealth Modalities, Sept. 19, 2023, (Accessed Nov. 2024).

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GEOGRAPHIC LIMITS

No reference found.

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FACILITY TRANSMISSION FEE

The department will not pay

• for the use, or any costs associated with the use, of technological equipment and systems associated with the delivery of a service by means of a telehealth modality;
• a provider for communication with that provider’s supervising provider or communication with a provider who is acting in a supervisory capacity;
• a supervising provider or a provider who is acting in a supervisory capacity for communication with a supervisee or for review of a supervisee’s work;
• a provider participating in a telehealth encounter whose sole purpose is to facilitate the telehealth encounter between the recipient and a rendering provider or a consulting provider;
• for a failed or unsuccessful telehealth connection or transmission

SOURCE: AK Admin. Code, Title 7, 110.635. (Accessed Nov. 2024).

Last updated 11/22/2024

Miscellaneous

Are there additional documentation requirements when a service is provided via a telehealth modality?

Yes: Telehealth services are documented episodes of care and require the same clinical documentation as seeing a member in-person, identified in 7 AAC 105.230, plus documentation that describes the telehealth visit, including:

• Modality: Delivery method (e.g., two-way audio-video or Two-Way Audio Only, and patient initiated online digital services)
• Location: Member/provider location during encounter (e.g., home, clinic)
• Consent: Record of the member giving consent for the telehealth encounter

Does documentation need to include the physical address when documenting the location of the encounter?

No: documentation should identify where the patient and provider are located (e.g., home, clinic), but the address of the locations are not needed.

Who may prescribe a substance via telehealth? Under what conditions?

Annual in-person exam is not required when:

• Alaska-licensed physicians (including osteopaths and podiatrists) and physician assistants may prescribe a controlled substance via telehealth if the provider complies with AS 08.64.364 and federal law.
• Alaska-licensed APRNs may prescribe a controlled substance via telehealth if the provider complies with AS 08.68.710 and federal law.
• Prescription, dispensation, and administration of a controlled substance may not be conducted via telehealth except by physicians (including osteopaths and podiatrists), physician assistants, or APRNs.
• Alaska-licensed dentists and optometrists may only prescribe a controlled substance via telehealth subsequent to an in-person exam.

SOURCE: Alaska Medicaid Frequently Asked Questions Coverage of Telehealth Modalities, Sept. 19, 2023), (Accessed Nov. 2024).

Medical Assistance Reform Program

The department shall identify the areas of the state where improvements in access to telehealth would be most effective in reducing the costs of medical assistance and improving access to health care services for medical assistance recipients. The department shall make efforts to improve access to telehealth for recipients in those locations. The department may enter into agreements with Indian Health Service providers, if necessary, to improve access by medical assistance recipients to telehealth facilities and equipment.

SOURCE: Alaska Statute 47.05.270, (Accessed Nov. 2024).

Last updated 11/22/2024

Out of State Providers

When can an out-of-state provider not licensed in Alaska provide services to a member located in Alaska?

Physicians who are licensed in another state may practice telehealth without an Alaska license if:

• The physician and patient have an established physician-patient relationship and the physician has previously conducted an in-person examination of the patient; or
• If the patient has a suspected or diagnosed life-threatening condition for which the patient has been referred by an Alaska-licensed physician to a physician licensed in another state and the visit relates to that condition.

SOURCE: Alaska Medicaid Frequently Asked Questions Coverage of Telehealth Modalities, Sept. 19, 2023, (Accessed Nov. 2024).

Subject to the requirements of 7 AAC 110.620 – 7 AAC 110.639, to be eligible for payment under 7 AAC 105 – 7 AAC 160 for providing a service by means of a telehealth modality, a provider must meet the following requirements:

1. the provider must have an active license under AS 08 or AS 47, an active certification in the state, or an active license under the applicable laws of the jurisdiction in which the provider is located;
2. the provider must be enrolled under 7 AAC 105.210;
3. the provider, if licensed under AS 08 and required under 12 AAC 02.600, must be registered under 12 AAC 02.600 (telemedicine business registry);
4. the service must be delivered within the rendering provider’s, and if applicable, consulting provider’s scope of licensure or certification;
5. a claim submitted to the department must include applicable telehealth modifiers and place-of-service coding;
6. if the rendering provider or consulting provider determines, during a telehealth encounter, that a service extends beyond the scope of that provider’s license or certification, the provider must discontinue the encounter and refer the recipient to an appropriate provider; the rendering provider or consulting provider may bill only for the portion of the encounter that was within that provider’s scope of license or certification and only if the rendered portion of the encounter met all criteria of a separately billable service;
7. except as otherwise provided in 7 AAC 105 – 7 AAC 160, a recipient must be present during and participate in a telehealth encounter;
8. the provider must comply with all record keeping requirements set out under 7 AAC 105.230 for all telehealth services rendered;
9. the rendering provider and consulting provider, when delivering a service by means of a synchronous telehealth modality, must annotate the patient’s clinical record with the method of delivery, the recipient’s location during the delivery of the service, and confirmation that the recipient has consented to a telehealth method of delivery.

SOURCE:  AK Admin. Code, Title 7, 110. 630 (Accessed Nov. 2024).

The Travel Service Authorization Request form has been updated to include a section for providers to declare what telehealth considerations were done prior to requesting travel.

SOURCE: AK MMIS Fiscal Agent Transition Town Hall, Dec. 20, 2023, & Travel Service Authorization Request Form, (Accessed Nov. 2024).

Last updated 11/22/2024

Overview

Alaska reimburses for Live Video, Store & Forward & audio-only.  They also reimburse for patient-initiated services in some circumstances. It is unclear if they reimburse for remote patient monitoring.

In Sept. 2023, Medicaid updated their telehealth regulations to comply with statute.  They are currently working on telehealth guidance and reviewing their provider manuals.  In the meantime, their Telehealth Coverage and Reimbursement FAQs is meant to answer the most common questions.

Last updated 11/22/2024

Remote Patient Monitoring

POLICY

Alaska Medicaid will pay for telemedicine services delivered in the following manner: …

• Self-monitoring method: The patient is monitored in his or her home via a telemedicine application, with the provider indirectly involved from another location.

Note: Manual is under review.

SOURCE: State of AK Dept. of Health and Social Svcs., Alaska Medical Assistance Provider Billing Manuals for Physician, ARNP, PA Services (5/13), p. 31, (Accessed Nov. 2024).

* A provider has notified CCHP that Alaska Medicaid currently only pays for the RPM device and not the actual service. This has not been verified.

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CONDITIONS

No Reference Found

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PROVIDER LIMITATIONS

No Reference Found

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OTHER RESTRICTIONS

No Reference Found

Last updated 11/22/2024

Store and Forward

POLICY

The department shall pay for all services covered by the medical assistance program provided through telehealth in the same manner as if the services had been provided in person, including …

• services provided through audio, visual, or data communications, alone or in any combination, or through communications over the Internet or by telephone, including a telephone that is not part of a dedicated audio conference system, electronic mail, text message, or two-way radio

SOURCE: AK Statute Sec. 47.07.069, (Accessed Nov. 2024).

Alaska Medicaid will reimburse for Store & Forward telehealth, which is defined as the “provider sends digital images, sounds, or previously recorded video to a consulting provider at a different location.  The consulting provider reviews the information and reports back his or her analysis.”

Note: Manual is under review.

SOURCE: State of AK Dept. of Health and Social Svcs., Alaska Medical Assistance Provider Billing Manuals for Physician, ARNP and PA Services (5/13), p. 31, (Accessed Nov. 2024).

Subject to the requirements of 7 AAC 110.620 – 7 AAC 110.639, the department will pay for a service delivered by means of one of the following telehealth modalities if the modality and use of the modality meet the requirements of P.L. 104 – 191 (Health Insurance Portability and Accountability Act of 1996 (HIPAA)): …

• asynchronous: a store-and-forward, through the transfer from one location to another, of recorded digital images, data, video, or sounds to allow a consulting provider to obtain information, analyze it, and report back to the rendering provider.

For patient-initiated online digital service, whether synchronous or asynchronous, the following are not reimbursable:

• nonevaluative or nonmanagement services including appointment scheduling and electronic communication of test results;
• provider-initiated online digital service;
• patient-initiated online digital service within the postoperative period of a completed procedure or within seven days of an in-person visit and related to the illness, injury, or other reason for that visit.

SOURCE:  Alaska Admin Code. Title 7, Sec. 110.625. (Accessed Nov. 2024).

What are the covered modalities for telehealth services?

Asynchronous:

• Store-and-Forward: The transfer between healthcare providers of recorded digital images, video, or sounds from one location to another.

Patient-Initiated Online Digital Services:

• Synchronous or asynchronous: Evaluation, assessment, and management services of an established patient through a secure platform such as an electronic record portal, secure electronic mail, or digital application.

What is a patient-initiated online digital service?

An online digital service is meant to expand a patient’s options to communicate health concerns and request clarification. They also enhance a provider’s ability to evaluate and manage a patient’s healthcare where an in-person or telehealth encounter is not warranted.

• Separately Reimbursable Communications: Patient-initiated internet-based communications (e.g., patient portal messaging, text messaging, or email) for healthcare related reasons such as medication questions, prescription generation, clarification on test results, and reporting symptoms.
• Non-Covered Communications: Use of online digital services for nonevaluative, non-management administrative functions such as updating the patient’s insurance or scheduling an appointment are not reimbursable.
• Provider Initiated Communications: Providers are not prohibited from initiating communication through methods such as internet communications, electronic mail, and text messages but these are not reimbursable services.

What provider types are authorized to bill for patient initiated online digital services?

CPT Codes 98970-98972: Covered for behavioral health aides under the direction of a physician, psychologists, and school districts enrolled as a school-based
services provider. Federally Qualified Health Centers and Rural Health Centers may be reimbursed at their encounter rate for services provided by licensed clinical social workers, marital and family therapists, professional counselors, and psychologists.

CPT Codes 99421-99423: Covered for advanced practice registered nurses, audiologists, Community Health Aides, direct entry midwives, optometrists, physicians, physician assistants, and podiatrists. Federally Qualified Health Centers and Rural Health Clinic may be reimbursed at the facility’s encounter rate for services provided by a rendering providers listed here.

When are patient-initiated online digital services separately reimbursable?

Patient-initiated online digital services are separately reimbursable if the communication is:

• Established Patient: Only reimbursable for an established patient,
• Evaluative in Nature: The purpose is to evaluate, assess, or manage the member’s healthcare,
• Patient-Initiated: Call must be initiated by the member or member’s guardian without prompting, and
• No other Affiliated Service: Not separately reimbursable if affiliated to another evaluation and management service, assessment, or procedure.

Online digital services are not separately reimbursable if they are within seven days of (before or after) an in-person or telehealth (asynchronous or synchronous) visit directly related to the illness, injury, or other reason for that visit.

SOURCE: Alaska Medicaid Frequently Asked Questions Coverage of Telehealth Modalities, Sept. 19, 2023, (Accessed Nov. 2024).

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ELIGIBLE SERVICES/SPECIALTIES

Procedure Code Modifier:

• Two-Way Audio-Video Technology: GT or 95
• Store-and-Forward: GQ
• Two-Way Audio Only Technology : FQ and 93

Procedure Codes Defined as Audio Only: Failure to include either modifier FQ or modifier 93 will result in denial of payment for audio only services.

Patient Initiated Online Digital Services: Do not use telehealth modifiers when billing CPT codes 98970 – 98972 and 99421 – 99423.

Telehealth for Acute Stroke: Use procedure code modifier G0 (G-Zero) and the appropriate telehealth modifier (GT, 95, GQ, or FQ).

Helpful Hint: Modifier G0 (G-Zero) often gets confused with GO (G-Oh). Please ensure the appropriate modifier is utilized when billing either G0 (G-Zero) or GO (G-Oh).

SOURCE: Alaska Medicaid Frequently Asked Questions Coverage of Telehealth Modalities, Sept. 19, 2023, (Accessed Nov. 2024).

The department will not pay

• for the use, or any costs associated with the use, of technological equipment and systems associated with the delivery of a service by means of a telehealth modality;
• a provider for communication with that provider’s supervising provider or communication with a provider who is acting in a supervisory capacity;
• a supervising provider or a provider who is acting in a supervisory capacity for communication with a supervisee or for review of a supervisee’s work;
• a provider participating in a telehealth encounter whose sole purpose is to facilitate the telehealth encounter between the recipient and a rendering provider or a consulting provider;
• for a failed or unsuccessful telehealth connection or transmission;
• for the following services when provided by means of a telehealth modality:
  • chiropractic services;
  • dental services;
  • private-duty nursing services;
  • pharmacy dispensing services;
  • durable medical equipment and related services;
  • prosthetic and orthotic devices and related services;
  • transportation services;
  • accommodation services;
  • personal care services;
  • home health services;
  • community First Choice services;
  • home and community-based waiver services, except for
    • care coordination services under 7 AAC 130.240;
    • day habilitation services under 7 AAC 130.260;
    • employment services under 7 AAC 130.270; or
    • intensive active treatment services under 7 AAC 130.275;

SOURCE:  AK Admin. Code, Title 7, 110. 635 (Accessed Nov. 2024).

A consulting provider may send data he/she has received during a store-and-forward telemedicine consultation to another consulting provider (with equal or greater scope of practice as determined by his/her occupational license or level of expertise within their field of specialty).

NOTE: Manual is under review.

SOURCE: AK Dept. of Health and Social Svcs. Billing for Telemedicine Services. Section II: Professional Claims Management, Feb. 6, 2020, pg. 20, (Accessed Nov. 2024).

Covered telemedicine services are limited to:

• An initial visit
• One follow-up visit;
• A consultation made to confirm diagnosis;
• Diagnostic, therapeutic or interpretive service;
• A psychiatric or substance abuse assessment;
• Psychotherapy; or
• Pharmacological management services on an individual recipient basis.

Note: Manual is under review.

SOURCE: State of AK Dept. of Health and Social Svcs., Alaska Medical Assistance Provider Billing Manuals for Physician, ARNP, PA Services (5/13), p. 31, (Accessed Nov. 2024).

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GEOGRAPHIC LIMITS

No Reference Found

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TRANSMISSION FEE

The department will not pay

• for the use, or any costs associated with the use, of technological equipment and systems associated with the delivery of a service by means of a telehealth modality;
• a provider for communication with that provider’s supervising provider or communication with a provider who is acting in a supervisory capacity;
• a supervising provider or a provider who is acting in a supervisory capacity for communication with a supervisee or for review of a supervisee’s work;
• a provider participating in a telehealth encounter whose sole purpose is to facilitate the telehealth encounter between the recipient and a rendering provider or a consulting provider;
• for a failed or unsuccessful telehealth connection or transmission

SOURCE: AK Admin. Code, Title 7, 110.635. (Accessed Nov. 2024).