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AristaMD is a clinical telehealth and specialty care coordination platform that provides asynchronous, clinician-to-clinician electronic consultations (eConsults) and referral management workflows across primary care networks, health systems, Federally Qualified Health Centers (FQHCs), and accountable care organizations (ACOs). By integrating directly with electronic health record (EHR) systems via SMART on FHIR and HL7 interfaces, AristaMD enables primary care providers (PCPs) to transmit structured patient records and targeted clinical questions to a national panel of board-certified specialists across more than 70 specialties and subspecialties, receiving a formal written assessment and care plan within hours without requiring the patient to wait weeks or months for an in-person specialty visit.
What Is AristaMD? (Platform Scope and Clinical Architecture)
In outpatient health systems, specialty access bottlenecks frequently delay diagnosis and drive avoidable emergency department utilization, while a substantial proportion of routine specialty referrals involve clinical questions that can be resolved through chart review and targeted diagnostic or medication adjustments in the primary care setting. According to AristaMD’s platform documentation (aristamd.com), the platform addresses this primary-to-specialty interface through three core modules:
- Asynchronous Physician-to-Physician eConsult Platform: Connects requesting PCPs, nurse practitioners, and physician assistants with either the health system’s own internal specialists or AristaMD’s contracted national panel of board-certified specialists across 70+ adult and pediatric specialties (including cardiology, endocrinology, dermatology, neurology, rheumatology, hematology, nephrology, gastroenterology, and psychiatry).
- Evidence-Based Clinical Workup Checklists: Embeds specialty-specific clinical decision support prompts at the point of referral order entry, guiding the requesting clinician on the baseline laboratory panels, diagnostic imaging, or clinical scores needed to evaluate the condition or prepare a high-yield referral.
- Specialty Care Coordination and Referral Triage: When an eConsult determines that the patient requires an in-person procedure or face-to-face specialist evaluation, the platform packages the completed pre-visit workup and specialist notes to expedite high-acuity scheduling.
How Is AristaMD Used in Clinical Research and Healthcare Workflows?
In both routine ambulatory clinical operations and implementation science / health services research studying specialty care access (such as Medicaid safety-net networks and OCHIN-hosted community health centers), an AristaMD eConsult follows a five-step closed-loop clinical and informatics workflow:
| Workflow Step | Clinician / System Actor | EHR & Interoperability Execution |
|---|---|---|
| 1. Patient Verbal Consent & Clinical Question Formulation | Treating Primary Care Provider (PCP) | During or following an encounter, the PCP discusses the need for an interprofessional specialist consultation with the patient, informs them of any applicable cost-sharing, and documents verbal consent in the EHR progress note. |
| 2. In-EHR SMART on FHIR Launch & Clinical Data Packaging | EHR Interface Engine / SMART on FHIR App | The PCP launches AristaMD directly from the patient’s chart (supported across Epic, Oracle Health/Cerner, athenahealth, NextGen, eClinicalWorks, and OCHIN). Using HL7 FHIR (US Core Patient, Condition, MedicationRequest, Observation, and DiagnosticReport) or HL7 v2 / C-CDA feeds, the platform automatically attaches recent labs, imaging reports, problem lists, and clinical notes—plus clinical photographs for teledermatology or ECG tracings for telecardiology. |
| 3. Automated Routing to State-Licensed Specialist | AristaMD Routing Engine | The platform matches the clinical specialty, subspecialty requirements, and patient’s state of residence against its credentialed specialist directory and notifies the assigned board-certified specialist. |
| 4. Asynchronous Specialist Assessment & Written Report | Board-Certified Consulting Specialist | The specialist reviews the clinical question and attached EHR records, documents consultative time, and authors a structured written consultation report detailing differential considerations, recommended medication titrations, further diagnostic testing, and explicit red-flag criteria for in-person referral. |
| 5. Bidirectional EHR Write-Back & Care Plan Execution | Treating PCP & EHR Document/Order Interface | The signed specialist report writes back directly into the originating EHR chart (via HL7 MDM^T02 / ORU^R01 or FHIR DocumentReference / ServiceRequest), alerting the PCP in their EHR inbox to implement the treatment plan and communicate results to the patient. |
CMS Reimbursement & Coding Governance: CPT 99451 and CPT 99452
Unlike synchronous real-time audio-video telemedicine visits (which use standard Evaluation and Management [E/M] codes with CPT Modifier 95), asynchronous physician-to-physician eConsults on platforms like AristaMD are reimbursed by Medicare, most state Medicaid programs, and commercial payers under the Interprofessional Telephone/Internet/Electronic Health Record Consultations code family in the CMS Medicare Physician Fee Schedule:
| CPT Code | Billing Practitioner | CMS Time Threshold & Mandatory Documentation Elements |
|---|---|---|
CPT 99452 |
Treating / Requesting Practitioner (e.g., PCP, NP, PA) | Requires 16 to 30 minutes of service time spent preparing for the referral and/or communicating with the consultant (cannot be billed more than once per 14-day period per patient). Chart must document: (1) advance patient verbal consent (including cost-sharing awareness), (2) the specific clinical question and medical necessity, (3) preparation/submission time, and (4) review of the consultant’s returned report. |
CPT 99451 |
Consulting Specialist (Board-certified specialist reviewing the eConsult) | Requires 5 minutes or more of medical consultative time reviewing the patient’s chart, labs, and imaging (with more than 50% of total time devoted to medical consultative verbal or internet/EHR assessment, and concluded with a formal written report transmitted to the treating practitioner). Cannot be billed if the specialist saw the patient within the prior 14 days or if the consultation results in an immediate transfer of care or scheduled visit with that same specialist within the next 14 days (or next available appointment). |
Strengths and Boundaries for Clinical Operations and Health Services Research
- Strength — Rapid Specialty Triage and Reduced Wait Times: Resolving routine diagnostic and therapeutic questions asynchronously keeps lower-acuity management in the primary care medical home while preserving in-person specialty clinic slots for patients who require invasive procedures or complex longitudinal specialty care.
- Strength — Standardized Structured Data for Pragmatic Trials and Implementation Research: Because every eConsult records the clinical question, baseline labs/medications, specialist turnaround time, and whether an in-person visit was avoided or recommended, health services researchers use EHR-integrated eConsult datasets to evaluate specialty care disparities, rural/safety-net access, and total cost of care.
- Boundary — Non-Emergent Asynchronous Scope: Asynchronous eConsults are designed for non-urgent outpatient or subacute clinical questions. Patients presenting with acute unstable symptoms require immediate emergency transfer or synchronous specialist escalation rather than an asynchronous chart consultation.
Frequently Asked Questions
What is AristaMD?
AristaMD is a healthcare technology platform that enables asynchronous, physician-to-physician electronic consultations (eConsults) and specialty referral management, connecting primary care providers (PCPs) with a national panel of board-certified specialists across more than 70 clinical specialties and subspecialties to deliver evidence-based treatment plans directly inside the electronic health record (EHR).
How is AristaMD used in clinical research and healthcare?
In ambulatory healthcare, Federally Qualified Health Centers (FQHCs), accountable care organizations (ACOs), and pragmatic health services research, AristaMD is used to replace low-acuity face-to-face specialty referrals with rapid asynchronous specialist assessments. Primary care clinicians submit a clinical question with packaged EHR chart data (labs, imaging, medications, problem list) via SMART on FHIR or HL7 interfaces, and a board-certified specialist returns a written diagnostic and therapeutic plan—typically within hours—allowing the patient to be managed in the primary care setting while billing interprofessional consultation codes CPT 99451 and CPT 99452.
How do CPT 99451 and CPT 99452 apply to AristaMD eConsult workflows?
Under the CMS Medicare Physician Fee Schedule, interprofessional electronic consultations are billed using two complementary codes: CPT 99452 is billed by the treating/requesting primary care practitioner who obtains patient verbal consent, prepares and submits the clinical question (requiring 16 to 30 minutes of consultative preparation/review time), and integrates the specialist’s recommendations; CPT 99451 is billed by the consulting specialist who spends at least 5 minutes reviewing the clinical record and returns a formal written report to the treating clinician.
Sources
- AristaMD — Specialty Care Coordination & eConsult Platform Documentation: aristamd.com
- HL7 SMART App Gallery — AristaMD SMART on FHIR EHR Integration Profile: apps.smarthealthit.org
- Centers for Medicare & Medicaid Services (CMS) — Medicare Physician Fee Schedule Interprofessional Telephone/Internet/EHR Consultations (CPT 99451 and CPT 99452): cms.gov
