Arkansas Telemedicine & Telehealth Reimbursement Overview

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

The healthcare professional should follow existing state and federal laws regarding informed consent.

See AR Code 17-80-117(c)

 

A health plan shall cover telehealth-delivered services on the same basis as it would in-person services.
See AR Code 23-79-1602(c)

Effective 1/1/18
Health plans required to reimburse for Telemedicine, which includes Store & Forward

See AR Code 17-80-117(b)

Effective 1/1/18
A health plan must provide a reasonable facility fee to an originating site if they are licensed to bill the health plan.

See AR Code 23-79-1602

The state’s telemedicine law was revised to remove originating site restrictions that required the patient to be in a healthcare facility.  It is now defined as, “a site at which a patient is located at the time healthcare services are provided to him or her by means of telemedicine.”  Providing the ultimate flexibility in patient location.

See SB 146

No Reference Found

Medicaid

Patient consent is required.

Arkansas Medicaid shall provide payment to a licensed or certified healthcare professional or a licensed or certified entity for services provided through telemedicine if the service provided through telemedicine is comparable to the same service provided in person.

 

Coverage and reimbursement for services provided through telemedicine will be on the same basis as for services provided in person. While a distant site facility fee is not authorized under the Telemedicine Act, if reimbursement includes payment to an originating site (as outlined in the above paragraph), the combined amount of reimbursement to the originating and distant sites may not be less than the total amount allowed for healthcare services provided in person.

Medicaid Provider Manual – Section i | General Policy (See Section 105.190)

Store-and-forward and remote monitoring are referenced in Arkansas definition of telemedicine, but there isn’t a specific reference to reimbursement outside of live video.
Medicaid Provider Manual – Section i | General Policy (See Section 105.190)

Payment will include a reasonable facility fee to the originating site operated by a licensed or certified healthcare professional or licensed or certified healthcare entity if the professional or entity is authorized to bill Arkansas Medicaid directly for healthcare services.

Medicaid Provider Manual – Section i | General Policy (See Section 105.190)

The state’s telemedicine law was revised to remove originating site restrictions that required the patient to be in a healthcare facility.  It is now defined as, “a site at which a patient is located at the time healthcare services are provided to him or her by means of telemedicine.”  Providing the ultimate flexibility in patient location.

See SB 146

To find out if your provider class is eligible for medicaid reimbursement reference the appropriate  medicaid manual for your specialty.
Arkansas Provider Manual

 

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

The healthcare professional should follow existing state and federal laws regarding informed consent.

See AR Code 17-80-117(c)

 

Medicaid

Patient consent is required.

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Live Video Reimbursement
State Law

A health plan shall cover telehealth-delivered services on the same basis as it would in-person services.
See AR Code 23-79-1602(c)

Medicaid

Arkansas Medicaid shall provide payment to a licensed or certified healthcare professional or a licensed or certified entity for services provided through telemedicine if the service provided through telemedicine is comparable to the same service provided in person.

 

Coverage and reimbursement for services provided through telemedicine will be on the same basis as for services provided in person. While a distant site facility fee is not authorized under the Telemedicine Act, if reimbursement includes payment to an originating site (as outlined in the above paragraph), the combined amount of reimbursement to the originating and distant sites may not be less than the total amount allowed for healthcare services provided in person.

Medicaid Provider Manual – Section i | General Policy (See Section 105.190)

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Store & Forward Reimbursement
State Law

Effective 1/1/18
Health plans required to reimburse for Telemedicine, which includes Store & Forward

See AR Code 17-80-117(b)

Medicaid

Store-and-forward and remote monitoring are referenced in Arkansas definition of telemedicine, but there isn’t a specific reference to reimbursement outside of live video.
Medicaid Provider Manual – Section i | General Policy (See Section 105.190)

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Originating Site & Transmission Fees
State Law

Effective 1/1/18
A health plan must provide a reasonable facility fee to an originating site if they are licensed to bill the health plan.

See AR Code 23-79-1602

The state’s telemedicine law was revised to remove originating site restrictions that required the patient to be in a healthcare facility.  It is now defined as, “a site at which a patient is located at the time healthcare services are provided to him or her by means of telemedicine.”  Providing the ultimate flexibility in patient location.

See SB 146

Medicaid

Payment will include a reasonable facility fee to the originating site operated by a licensed or certified healthcare professional or licensed or certified healthcare entity if the professional or entity is authorized to bill Arkansas Medicaid directly for healthcare services.

Medicaid Provider Manual – Section i | General Policy (See Section 105.190)

The state’s telemedicine law was revised to remove originating site restrictions that required the patient to be in a healthcare facility.  It is now defined as, “a site at which a patient is located at the time healthcare services are provided to him or her by means of telemedicine.”  Providing the ultimate flexibility in patient location.

See SB 146

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Eligible Practitioners
State Law

No Reference Found

Medicaid

To find out if your provider class is eligible for medicaid reimbursement reference the appropriate  medicaid manual for your specialty.
Arkansas Provider Manual

 

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

Yes, a health benefit plan shall provide coverage and reimbursement for healthcare services provided through telemedicine on the same basis as the health benefit plan provides coverage and reimbursement for health services provided in person, unless this subchapter specifically provides otherwise.

See SB 146

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: