Arizona Telemedicine & Telehealth Reimbursement Overview

Provider Reimbursement Eligibility
Consent for Telemedicine Live Video Reimbursement Store & Forward Reimbursement Originating Site & Transmission Fees Eligible Practitioners
State Law

Before providing telemedicine, providers must obtain and document or written consent.

See Arizona Revised Statute Sec. 36-3602.

Live, synchronous video is included in the definition of telemedicine under Arizona 20-1057.13. is therefore covered by parity law.  Arizona SB1089 removes live video restrictions for specific specialties starting on Dec. 31, 2020.

Arizona SB1089 expands telemedicine to include asynchronous communication, remote patient monitoring, and store-and-forward.  Audio-only telephone, a video‑only system, a facsimile machine, instant messages or electronic mail are not reimbursable.

Effective date – Dec. 31, 2020

Arizona SB1089 – Removes prior geographic restrictions and originating site restrictions, any patient insured by a corporation can be seen via telemedicine from virtually any location, including the home.  A provider is not required to be present with the patient at the originating site.  Effective Dec. 31, 2020.

Arizona state law requires that telemedicine visits be covered as if they were covered in-person.  Arizona SB1089 eliminates restrictions on eligible providers types that can provide care via telemedicine.  Effective Dec. 31, 2020.

Medicaid

Separate consent is required if there will be a recording of the video session.

See Pg. 320-24 in the Arizona Medicaid Policy

AHCCCS will reimburse for specific, medically necessary services provided via live video. They use a fee for service program, and the eligible services can be found in the provider manual.
See Pg. 36 in Chapter 10 of the AHCCCS Provider Manual

AHCCCS includes store-and-forward telemedicine in their reimbursement for live video services.

See Pg. 36 in Chapter 10 of the AHCCCS Provider Manual

AHCCCS doesn’t require the provider to be present at an originating/spoke site, nor does it identify specific examples of originating sites, which should make the home a valid originating/spoke site.

AHCCCS will not cover spoke/originating site facility fees.

See page 41 of the Fee-For-Service Provider Billing Manual

AHCCCS provides a list of medical services that are covered for real-time and store-and-forward telemedicine services:

See Page 41 of the Fee-For-Service Provider Billing Manaual

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

See Telemedicine Reimbursement Guide – Medicare Section

See Telemedicine Reimbursement Guide – Medicare Section

See Telemedicine Reimbursement Guide – Medicare Section

See Telemedicine Reimbursement Guide – Medicare Section

Private Payors

Private payors are actively exploring telemedicine and telehealth, but each provider is different. If you are in network with a specific provider, call and request documentation of their policy related to telehealth.

Self Pay

There are no limitations for self pay patients/clients, and providing telehealth services is a great way to increase revenue with patients that are selfpay or value premium services.

Provider Reimbursement Eligibility
Consent for Telemedicine
State Law

Before providing telemedicine, providers must obtain and document or written consent.

See Arizona Revised Statute Sec. 36-3602.

Medicaid

Separate consent is required if there will be a recording of the video session.

See Pg. 320-24 in the Arizona Medicaid Policy

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Live Video Reimbursement
State Law

Live, synchronous video is included in the definition of telemedicine under Arizona 20-1057.13. is therefore covered by parity law.  Arizona SB1089 removes live video restrictions for specific specialties starting on Dec. 31, 2020.

Medicaid

AHCCCS will reimburse for specific, medically necessary services provided via live video. They use a fee for service program, and the eligible services can be found in the provider manual.
See Pg. 36 in Chapter 10 of the AHCCCS Provider Manual

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Store & Forward Reimbursement
State Law

Arizona SB1089 expands telemedicine to include asynchronous communication, remote patient monitoring, and store-and-forward.  Audio-only telephone, a video‑only system, a facsimile machine, instant messages or electronic mail are not reimbursable.

Effective date – Dec. 31, 2020

Medicaid

AHCCCS includes store-and-forward telemedicine in their reimbursement for live video services.

See Pg. 36 in Chapter 10 of the AHCCCS Provider Manual

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Originating Site & Transmission Fees
State Law

Arizona SB1089 – Removes prior geographic restrictions and originating site restrictions, any patient insured by a corporation can be seen via telemedicine from virtually any location, including the home.  A provider is not required to be present with the patient at the originating site.  Effective Dec. 31, 2020.

Medicaid

AHCCCS doesn’t require the provider to be present at an originating/spoke site, nor does it identify specific examples of originating sites, which should make the home a valid originating/spoke site.

AHCCCS will not cover spoke/originating site facility fees.

See page 41 of the Fee-For-Service Provider Billing Manual

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Eligible Practitioners
State Law

Arizona state law requires that telemedicine visits be covered as if they were covered in-person.  Arizona SB1089 eliminates restrictions on eligible providers types that can provide care via telemedicine.  Effective Dec. 31, 2020.

Medicaid

AHCCCS provides a list of medical services that are covered for real-time and store-and-forward telemedicine services:

See Page 41 of the Fee-For-Service Provider Billing Manaual

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Private Payors

Private payors are actively exploring telemedicine and telehealth, but each provider is different. If you are in network with a specific provider, call and request documentation of their policy related to telehealth.

Self Pay

There are no limitations for self pay patients/clients, and providing telehealth services is a great way to increase revenue with patients that are selfpay or value premium services.

Telemedicine CPT Codes

Unique CPT codes do not exist specifically for telemedicine or telehealth. Instead a modifier is applied to existing codes.

  • For interactive audio and video sessions, place a GT modifier in front of the CPT codes you typically use for in person services.
  • For services provided via an asynchronous telecommunication system, simply add a GQ modifier in front of the CPT codes you typically use for in person services.

Telehealth Parity

Arizona’s telehealth statutes that went into effect January 1, 2018, provided a degree of parity but was ambiguous.

Arizona’s SB1089 will go into effect Dec. 31, 2020, and offers increased opportunities and parity allowances. See SB1089

Definitions

Telehealth Parity

Telehealth services are equal to in person services and reimbursed at the same rate.

Asynchronous Communication

The exchange of messages, such as among the hosts on a network or devices in a computer, by reading and responding as schedules permit rather than according to some clock that is synchronized for both the sender and receiver or in real time. Email, chat and text messaging are primary examples of asynchronous communication.

Distant or Hub Site

The location or site where the practitioner or provider is located while utilizing telemedicine services to meet with patients.

Originating Site

The location of the patient at the time services are provided. An originating site can be the client's home or a public facility like a rural hospital or physician's office. Many payors will reimburse for an originating site fee if it meets specific requirements. Rural use cases provide an applicable example for an eligible originating site fee where the patient will go to a local medical facility like a primary care physician's office and meet with a specialist located in distant urban health facility.

Additional Telemedicine Resources

Telehealth and telemedicine are fast growing and changing segments. Both state licensure and state legislation are changing rapidly along with federal legislation and for this reason the information provided cannot be considered legal advice. We make every attempt to keep state specific information up to date, but encourage you to validate this information through the following sites: