Last updated 01/26/2023
Definitions
“Telehealth” means the use of telecommunications services, as defined in section 269‑1, to encompass four modalities: store-and-forward technologies, remote monitoring, live consultation, and mobile health; and which shall include but not be limited to real-time video conferencing-based communication, secure interactive and non‑interactive web-based communication, and secure asynchronous information exchange, to transmit patient medical information, including diagnostic-quality digital images and laboratory results for medical interpretation and diagnosis, for the purpose of delivering enhanced health care services and information while a patient is at an originating site and the health care provider is at a distant site. Standard telephone contacts, facsimile transmissions, or e-mail text, in combination or by itself, does not constitute a telehealth service for the purposes of this section.”
SOURCE: HI Revised Statutes § 346-59.1(g). (Accessed Jan. 2023).
Telehealth services is the use of communication equipment to link health care practitioners and patients in different locations. It may be used in place of a face-to-face, “hands on” encounter for consultation, office visits, individual psychotherapy and pharmacologic management. For purposes of this section, the term “patient” refers to individuals eligible for medical assistance.
SOURCE: Code of HI Rules 17-1737-51.1(a). (Accessed Jan. 2023).
Dentistry & Federally Qualified Health Centers
“Telehealth” means the use of telecommunication services to transmit patient health information for interpretation and diagnosis while a patient is at an originating site and the health care provider is at a distant site. It is an enabling technology intended to facilitate access for patients who would otherwise not receive services without the provider being physically present. “Teledentistry” is a form of telehealth.
SOURCE: HI Med-QUEST Medicaid Provider Manual: Dental, pg. 108 (Jan. 2023)& Med-QUEST Memo 20-03 (QI- 2007). (Accessed Jan. 2023).
Last updated 01/26/2023
Live Video
POLICY
The State’s Medicaid managed care and fee-for-service programs shall not deny coverage for any service provided through telehealth that would be covered if the service were provided through in-person consultation between a patient and a health care provider. Hawaii Medicaid is required under statute to reimburse telehealth equivalent to reimbursement for the same services provided via face-to-face contact.
SOURCE: HI Revised Statutes § 346-59.1 (a & b). (Accessed Jan. 2023).
Interactive audio and video telecommunication systems must be used. Interactive telecommunications systems must be multi-media communications that, at a minimum, include audio and video equipment, permitting real-time consultation among the patient, consulting practitioner, and referring practitioner. Telephones, facsimile machines, and electronic mail systems do not meet the requirements of interactive telecommunications system. As a condition of payment the patient must be present and participating in the telehealth visit.
SOURCE: Code of HI Rules 17-1737-51.1(c). (Accessed Jan. 2023).
Hawaii’s State Plan Amendment for telehealth services was approved. Approval is retroactive to January 1, 2017. Hawaii state telehealth law 346-59.1 continues to be in effect and adhered to by QI health plans and Medicaid fee-for-service providers
SOURCE: HI Department of Human Servies, Med-QUEST Division, Quest Integration (QI) Health Plans Memo QI-2139/FF2 21-15. (Accessed Jan. 2023).
ELIGIBLE SERVICES/SPECIALTIES
GT, GQ or 95 modifiers must be used. See Attachment A for full list of CPT codes that are “prime candidates” for telehealth services. Distant site providers should use the 02 Place of Service Code. Codes listed in Attachment A are considered prime candidates for telehealth reimbursement.
SOURCE: QI-2139 Tele-Health Law (Act 226, SLH 2016) Implementation/FFS-21-15 (Replaces QI-1702A/FFS-1701A) (Accessed Jan. 2023).
Dentistry
The eligible codes for reimbursement will remain consistent with Memo QI-1702A (see Attachment A with the addition of code D0145. All eligible codes are subject to the processing policies as defined in Chapter 14 of the Medicaid Dental Provider Manual.
CDT code D9999 must be used to identify the claim for PPS payment by FQHCs and RHCs.
SOURCE: HI Med-QUEST Medicaid Provider Manual: Dental, pg. 108 (Jan. 2023)., HI Department of Human Services. Med-QUEST Division. Attachment A., HI MedQUEST Division, CTR 19-01 Reimbursement for Procedures Related to FQHC Teledentistry Services (Under FFS). (Accessed Jan. 2023).
Applied Behavioral Analysis & Autism Spectrum Disorder
Applied behavioral analysis services (including family adaptive behavior treatment guidance) can be provided through telehealth. MedQuest provides some areas of consideration when approving ABA services through telehealth (see memo). Memo QI 2301/FFS 23-01 Updates policy.
SOURCE: HI Med-QUEST Memo QI-2028 (Jul. 21, 2020), QI-2020 (Jun. 17, 2020), HI Med-Quest memo QI-2301/FFS 23-01.(January 13, 2023) (Accessed Jan. 2023).
Federally Qualified Health Centers
Eligible services will be consistent with Memo QI-1702A and FFS 19-01. See memo for specific billing scenarios. Memo QI- 2139/FFS 21-15 replaces Memo QI-1702A.
SOURCE: Med-QUEST Memo 20-07 (Mar. 16, 2020), QI-2139 Tele-Health Law (Act 226, SLH 2016) Implementation (Replaces QI-1702A), (Accessed Jan. 2023).
Community Integration Services (CIS)-Supportive Housing Services
CIS services may be rendered via telehealth as appropriate, as long as the required face-to-face interaction requirements are met (See Section 16, Service Settings for more information). Services rendered via telehealth shall be billed with the additional and appropriate telehealth modifiers, and applicable POS codes, as outline in memorandum QI-1702A (NOTE: QI-1702A has been replaced with QI-2139/FFS-21-15). Services may also be rendered via an approved telehealth modality, if determined by the health plan to be appropriate and effective and agreed to by the member.
SOURCE: Med-QUEST Memo QI-2105 (April 1, 2021). (Accessed Jan. 2023).
Induced/Intentional Termination of Pregnancy (ITOP) Evaluation & Management Services
Telehealth (audio-visual modality) may be used for evaluation and management services performed prior to the date of the medical ITOP. Codes in the range of 99201-99215 with modifiers 95, GQ, or GT are allowed.
SOURCE: Med-QUEST Memo FFS 2105 (May 7, 2021). (Accessed Jan. 2023).
QUEST Integration Health Plans & Community Case Management Agencies
Assessments and re-assessments may be conducted using telehealth and telecommunications technology only if an in-person interaction is not an option and should only be used on an exception basis. In-person interactions with members using appropriate safety precautions is the current expectation. Where possible, members at greatest risk and need should be prioritized to receive in-person interactions before members at lower risk and need.
The health plan must document the reason for conducting an interaction using a technology option.
SOURCE: Memo QI-2107A (April 29, 2021). (Accessed Jan. 2023).
Chronic Hepatitis C Infection
An in-person or telehealth/phone visit may be scheduled, if needed, for patient support, assessment of symptoms, and/or new medications.
SOURCE: HI Med-Quest Memo QI-2227/FFS 22-08 (December 30, 2022). (Accessed Jan. 2023).
ELIGIBLE PROVIDERS
Dentistry
Dental providers who are eligible to bill Hawaii Medicaid are also eligible to bill for telehealth for specific services (see Dental Manual Attachment A for details). The criteria for eligible dental providers are the same regardless whether or not telehealth is utilized (e.g., DDS or DMD).
SOURCE: HI Med-QUEST Medicaid Provider Manual: Dental, pg. 108-109 (Jan. 2023) & MedQuest Memo, Reimbursement for Procedures Related to Teledentistry Services, FFS No. 19-01, Mar. 13, 2019. (Accessed Jan. 2023).
Federally Qualified Health Centers
Providers who are eligible to bill for Hawaii Medicaid services are also eligible to bill for telehealth. Please refer to Hawaii Provider Manual Chapter 21 (21.2.1) for a list of eligible providers.
SOURCE: Med-QUEST FFS Memo 20-03 (Mar. 16, 2020), & HI Med-QUEST Medicaid Provider Manual: Federally Qualified Health Centers, Chapter 21 (21.2.1),pg. 2 (March 2016). (Accessed Jan. 2023)
ELIGIBLE SITES
Eligible originating sites listed in the Administrative Rules:
- The office of a physician or practitioner
- Hospitals;
- Critical Access Hospitals;
- Rural Health Clinics;
- Federally Qualified Health Centers;
- Federal telehealth demonstration project sites.
SOURCE: Code of HI Rules 17-1737-51.1(d), p. 70 – Law passed & state plan amendment accepted prohibiting this limitation, however the prohibiting language is still present in regulation (Accessed Jan. 2023).
In statute, these locations are also included:
- A patient’s home;
- Other non-medical environments such as school-based health centers, university-based health centers, or the work location of a patient.
SOURCE: HI Revised Statutes § 346-59.1. (Accessed Jan. 2023).
Approved state plan amendment authorizes HI Medicaid to remove geographic and originating site requirements.
SOURCE: HI State Plan Amendment 16-0004. (Accessed Jan. 2023).
Federally Qualified Health Centers:
The criteria for sites eligible to receive PPS payment is the same regardless whether or not tele-health is utilized. The services must be provided at an HRSA approved site or satellite. 5C (Other Activities/Locations) sites are not eligible to receive PPS reimbursement in Hawaii and therefore are not eligible to receive PPS for tele-health services.
The spoke (originating site) is the location where the patient is located whether accompanied or not by a health care provider through telehealth. The originating site includes a patient’s residence.
SOURCE: HI Med-QUEST FFS Memo 20-03. (Accessed Jan. 2023).
GEOGRAPHIC LIMITS
Telehealth services may only be provided to patients if they are presented from an originating site located in either:
- A federally designated Rural Health Professional Shortage Area;
- A county outside of a Metropolitan Statistical Area;
- An entity that participates in a federal telemedicine demonstration project.
SOURCE: Code of HI Rules 17-1737.-51.1. (Accessed Jan. 2023). – Law passed (HI Statute Section 346-59.1(c) & state plan amendment accepted prohibiting this limitation, however the prohibiting language is still present in regulation.
Approved state plan amendment authorizes HI Medicaid to remove geographic and originating site requirements.
SOURCE: HI State Plan Amendment 16-0004. (Accessed Jan. 2023).
Teledentistry
The criteria for eligible dental sites are the same regardless whether or not telehealth is utilized.
SOURCE: HI Med-QUEST Medicaid Provider Manual: Dental, pg. 108 (Jan. 2023) (Accessed Jan. 2023).
Federally Qualified Health Centers:
Services must be provided at an HRSA approved site or satellite.
The spoke (originating site) is the location where the patient is located whether accompanied or not by a health care provider through telehealth. The originating site includes a patient’s residence.
SOURCE: HI Med-QUEST Memo FFA 20-03. (Accessed Jan. 2023).
FACILITY/TRANSMISSION FEE
For FQHCs
When a spoke or originating site is solely used to facilitate tele-health, payment for the facilitation shall not exceed the published Medicare rate for transmission services for spoke sites.
SOURCE: HI Dept. of Human Services, Med-QUEST Division, Memo No. QI-2007/FFS 20-03. (Accessed Jan. 2023).
Last updated 01/27/2023
Overview
Hawaii Medicaid (Med-QUEST) reimburses for live video. Although their statute prohibits HI Medicaid from placing any restrictions on originating sites, regulations creating restrictions on the types or originating site eligible for reimbursement and their geographic location still exist in Hawaii Rules. HI indicated in a memo that a state plan amendment was approved that allows for the changes in Hawaii Medicaid policy based on the statutory requirements, but it did not provide any specifics on removing the originating site or geographic restrictions currently present in HI rules.
Additionally, according to Hawaii’s statutory definition of telehealth and limited documentation from Hawaii Medicaid, they appear to be reimbursing for store-and-forward and remote patient monitoring in certain circumstances.
Last updated 01/27/2023
Store and Forward
POLICY
Hawaii Medicaid and private payers are required to cover appropriate telehealth services (which includes store-and-forward) equivalent to reimbursement for the same services provided in-person.
SOURCE: HI Revised Statutes § 346-59.1 & 431:10A-116.3. (Accessed Jan. 2023).
To properly identify telehealth services, one of the following modifiers (95, GQ or GT) must always be used when billing with CPT or HCPCS code for telehealth services.
SOURCE: HI Med-QUEST Memo No. QI-2139/FFS 21-15 (Replaces QI-1702A/FFS-1701A) (Accessed Jan. 2023).
Hawaii Medicaid requires, as a condition of payment, the patient to be present and participating in the telehealth visit.
SOURCE: Code of HI Rules 17-1737.-51.1(c) p. 70 – Law passed & state plan amendment accepted prohibiting this limitation, however the prohibiting language is still present in regulation. (Accessed Jan. 2023).
Teledentistry
D9996 (teledentistry-asynchronous; information stored and forwarded to dentist for subsequent review) can be used to identify eligible telehealth delivered services.
SOURCE: HI Med-QUEST Medicaid Provider Manual: Dental, pg. 108 (Jan 2023) (Accessed Jan. 2023).
ELIGIBLE SERVICES/SPECIALTIES
Federally Qualified Health Centers
Telemedicine-based retinal imaging and interpretation is not a covered service for PPS reimbursement. A face-to-face encounter with a member by an ophthalmologist or optometrist is eligible for PPS reimbursement, regardless of whether retinal imaging or interpretation is a component of the services provided.
SOURCE: Med-QUEST Provider Manual. Ch. 21: Federally Qualified Health Centers. Mar. 2016, p. 4. (Accessed Jan. 2023).
GEOGRAPHIC LIMITS
No Reference Found
TRANSMISSION FEE
No Reference Found