May 8, 2020

State of Alabama
Press Release: Medicaid

Alabama Medicaid Updates Policies for Well Child Screenings and Other Services

PDF Version


TO:  Physicians, CRNPs, PAs, FQHCs, RHCs, Optometrists, ADPH, CRS


As Medicaid continues to monitor the outbreak of the Coronavirus Disease 2019 (COVID-19) in Alabama, we are extending policies to allow for additional codes to be delivered via telemedicine according to the Alert published on March 18, 2020 and May 1, 2020. Furthermore, Medicaid is allowing providers to bill for EPSDT screenings and evaluation and management visits on the same day of service.

 

Please see changes below:

 

  1. The following codes may be performed and billed via telemedicine utilizing place of service 02 and the modifier CR on the claims:

96110

96127

96160

96161

98966-98967**

D0145

**Will not count toward the annual physician office visit limit

  1. Medicaid is allowing the following EPSDT periodic screenings (well child checkups) codes to be billed via telemedicine, knowing not all components of the screening may be completed via telemedicine but will be completed in person when appropriate with no additional payment. Providers should bill with place of service 02 and modifiers CR and 52.

99381EP – 99385EP

99391EP – 99395EP

 

** Follow up visits in-person should occur as soon as possible to complete the remaining exam screening components. These exam visits can be billed for tracking purposes utilizing CPT 99201EP-99205 EP and 99211EP – 99215EP with modifier 52.

 

Providers are encouraged to continue in-person well child visits to receive necessary immunizations and other screenings of infants and young children (through 24 months of age) whenever possible.

  1. Medicaid is allowing the following procedure codes for in-person EPSDT screenings (well child checkups) and for evaluation and management (E/M office visits) visits to be billed on the same day of service with modifier 25 appended to codes 99201EP – 99215EP:

Well checkups: 99381EP – 99385EP, 99391EP – 99395EP

E/M visits: 99201EP – 99205EP, 99211EP - 99215EP


        As a reminder, providers should bill 99211EP – 99215EP for interperiodic screenings.

The effective dates for this Alert are March 16, 2020 -
May 30, 2020, or at the conclusion of the COVID-19 National emergency, whichever occurs first. Providers can begin submitting claims on May 22, 2020.

During the COVID-19 emergency, it is important to file claims as quickly as possible to ensure payment from Medicaid is made to Medicaid providers close to the date of service. The Centers for Medicare and Medicaid Services has increased the federal matching percentage for the emergency time frame, but states can only receive the increased match on claims that are paid during the emergency. Providers should include appropriate COVID-19 diagnosis code(s) on claims submitted to help with tracking of COVID-19.


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:
elizabeth.huckabee@medicaid.alabama.gov,
shauna.williams@medicaid.alabama.gov, beverly.churchwell@medicaid.alabama.gov




The Current Procedural Terminology (CPT) and Current Dental Terminology (CDT) codes descriptors, and other data are copyright © 20
20 American Medical Association and © 2020 American Dental Association (or such other date publication of CPT and CDT). All rights reserved. Applicable FARS/DFARS apply.




  • For more information, visit http://medicaid.alabama.gov
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