TO: Optometrists
As the Agency
continues to monitor the outbreak of the Coronavirus Disease 2019 (COVID-19) in
Alabama, we are extending telemedicine to ease access to appropriate medical
services for certain codes for your established patients who are recipients of
Alabama Medicaid.
What does the
extension include?
The extension of
telemedicine services is effective March 16, 2020. This
extension allows Optometrists to provide medically necessary services
that can be appropriately delivered via telecommunication services including
telephone consultations. These actions will be effective for one month,
expiring on dates of service April 16, 2020. It will be reevaluated
for a continuance as needed.
This is
applicable for recipients who wish to receive their care remotely
and limit their exposure to the virus. It can also serve as an initial
screening for recipients who may need to be tested for COVID-19. For guidance
on coronavirus testing, please refer to the Centers for Disease Control & Prevention, Alabama Department
of Public Health, and Alabama Department
of Mental Health websites.
Recipient
copayments will apply according to the Medicaid recipient handbook. A provider
may not deny services to an eligible recipient due to the recipient’s inability
to pay the copayment amount imposed.
Which types of
providers can perform telemedicine?
This applies to Optometrists
who are currently receiving Alabama Medicaid payments.
Which services
can be performed?
Telemedicine is
appropriate for consultations and visits for either low complexity, routine, or
ongoing evaluation and management. This would include acute illnesses and
chronic disease management that, based on the provider’s medical judgment, can
be managed by utilizing telecommunication services.
Which procedure
codes, modifiers, and place of service codes apply?
Medical providers
should bill established-patient evaluation and management codes 99211, 99212
and 99213. Standard documentation applies and additional billing
justification must be documented in the recipients’ medical records.
For Medicaid to
ensure proper reporting with the Centers for Medicare and Medicaid Services
(CMS), it is necessary to file the claim with place of service ‘02’
(telemedicine) and a modifier of ‘CR’ for catastrophic/disaster to assist with
claims tracking.
Providers should
only bill for telecommunications when the provider speaks directly with the
recipient. Providers should not bill Alabama Medicaid for services
when, for example, a nurse speaks to the recipient, even if the provider was consulted.
How will the
telemedicine services agreements and recipient consent forms apply?
Effective for
dates of service March 16, 2020 – April 16, 2020, the telemedicine services
agreement and recipient consent for will be waived. However, the provider
must receive verbal consent from the recipient, and the provider must document that
consent in the medical record.
When can a
provider submit a claim?
Providers should
begin submitting claims on March 20, 2020.
Will the 14
office visits limit apply?
Yes. The 14
office visit benefit will apply.
This Alert is an
interpretation based on guidance from Centers for Medicare and Medicaid
Services (CMS) as it relates to the COVID-19 pandemic emergency.
Alabama Medicaid
will review and verify that requirements for the extension of telemedicine
services are being met. Payments to providers that do not meet the
specifications are subject to recoupment.
If you have
questions, please visit the Medicaid website at www.medicaid.alabama.gov, or call
the Medicaid Fiscal Agent at 1.800.688.7989.
Contacts:
Calvin.binion@medicaid.alabama.gov,
Beverly.churchwell@medicaid.alabama.gov,
Elizabeth.huckabee@medicaid.alabama.gov