Last updated 06/09/2023
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. Except as provided through an interactive telecommunications system, standard telephone contacts, facsimile transmissions, or e-mail text, in combination or alone, do not constitute telehealth services.”
SOURCE: HI Revised Statutes § 346-59.1(g). As amended by HB907 HD2 SD2 (which has a repeal date of December 31, 2025) (Accessed Jun. 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 Jun. 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 Jun. 2023).
Last updated 06/10/2023
Email, Phone & Fax
Recently Passed Legislation – Effective until December 31, 2025.
Med-QUEST Division (MQD) supports the medically appropriate use of interactive telecommunications system using two-way, real-time audio-only communication technology (audio-only) to increase access to healthcare and promote continuity of care. MQD will continue to reimburse select healthcare services delivered through audio-only communication technology after the Federal PHE expires. The following guidance is in effect until December 31, 2025, which aligns with the amended Hawaii Revised Statute 346-59.1 as amended by 2023 Hawaii legislative session HB 907 HD 2 SD 2.
MQD will reimburse the codes identified as “audio-only interaction” as listed in the Centers for Medicare & Medicaid Services List of Telehealth Services/Medicare professional fee schedule (PFS)2 , which meet required conditions listed below, and which are recognized as Medicaid covered services. Federally Qualified Health Centers and Rural Health Centers will be reimbursed the prospective payment system rate when applicable. Codes approved for reimbursement are subject to change. See memo for additional guidelines and requirements.
SOURCE: HI Med-Quest Memo No: QI-2306, CCS-2302, FFS23-04 (May 12, 2023). (Accessed Jun. 2023).
Newly Amended Statute, Will be Repealed Dec. 31, 2025
Reimbursement for services provided through telehealth via an interactive telecommunications system shall be equivalent to reimbursement for the same services provided via in-person contact between a health care provider and a patient; provided that reimbursement for the diagnosis, evaluation, or treatment of a mental health disorder delivered through an interactive telecommunications system using two-way, real-time audio-only communication technology shall meet the requirements of title 42 Code of Federal Regulations section 410.78. Nothing in this section shall require a health care provider to be physically present with the patient at an originating site unless a health care provider at the distant site deems it necessary.
Except as provided through an interactive telecommunications system, standard telephone contacts, facsimile transmissions, or e-mail text, in combination or alone, do not constitute telehealth services.
SOURCE: HI Revised Statute, Sec. 346-59.1 as amended by HB 907HD 2/SD 2 (Accessed Jun. 2023).
No Reimbursement for:
- Telephone
- Facsimile machine
- Electronic mail
SOURCE: Code of HI Rules 17-1737.-51.1(c) p. 69 (Accessed Jun. 2023). (NOTE: Temporarily suspended by Memo No.: QI-2306; CCS-2302, FFS23-04 (May 12, 2023).)
Direct Acting Antiviral (DAA) Medications for Treatment of Chronic Hepatitis C Infection
For on-treatment monitoring, 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 No. QI-2227/FFS 22-08 (December 30, 2022). (Accessed Jun. 2023).
Last updated 06/09/2023
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.
Reimbursement for services provided through telehealth via an interactive telecommunications system shall be equivalent to reimbursement for the same services provided via in-person contact between a health care provider and a patient; provided that reimbursement for the diagnosis, evaluation, or treatment of a mental health disorder delivered through an interactive telecommunications system using two-way, real-time audio-only communication technology shall meet the requirements of title 42 Code of Federal Regulations section 410.78. Nothing in this section shall require a health care provider to be physically present with the patient at an originating site unless a health care provider at the distant site deems it necessary.
Reimbursement for services provided through telehealth via an interactive telecommunications system shall be equivalent to reimbursement for the same services provided via in-person contact between a health care provider and a patient; provided that reimbursement for two-way, real-time audio-only communication technology for purposes of diagnosis, evaluation, or treatment of a mental health disorder to a patient in the patient’s home shall be equivalent to eighty per cent of the reimbursement for the same services provided via in-person contact between a health care provider and a patient. To be reimbursed for telehealth via an interactive telecommunications system using two-way, real-time audio-only communication technology in accordance with this subsection, the health care provider shall first conduct an in-person visit or a telehealth visit that is not audio only, within six months prior to the initial audio-only visit, or within twelve months prior to any subsequent audio-only visit. The telehealth visit required prior to the initial or subsequent audio-only visit in this subsection shall not be provided using audio-only communication. Nothing in this section shall require a health care provider to be physically present with the patient at an originating site unless a health care provider at the distant site deems it necessary.
SOURCE: HI Revised Statutes § 346-59.1 (a & b). Amended by HB 907 HD2 SD 2 (Repeal date of December 31, 2025). (Accessed Jun. 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 Jun. 2023). (NOTE: Recent legislation not yet reflected in Rules)
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 Jun. 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 Jun. 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 (1702-A), CTR 19-01 Reimbursement for Procedures Related to FQHC Teledentistry Services (Under FFS-1901). (Accessed Jun. 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: QI-2020 (Jun. 17, 2020), HI Med-Quest memo QI-2301/FFS 23-01.(January 13, 2023) (Accessed Jun. 2023).
Federally Qualified Health Centers
Providers who are eligible to bill for Hawaii Medicaid services are also eligible providers who can bill for telehealth. 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 Jun. 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 Jun. 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 Jun. 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 Jun. 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 Jun. 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 Jun. 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 Jun. 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 Jun. 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 Jun. 2023).
Approved state plan amendment authorizes HI Medicaid to remove geographic and originating site requirements.
SOURCE: HI State Plan Amendment 16-0004. (Accessed Jun. 2023).
New Medicaid Policy Based on Recently Passed Legislation – Effective until December 31, 2025.
Interactive telecommunications system means, except as otherwise provided in this paragraph, multimedia communications equipment that includes, at a minimum, audio
and video equipment permitting two-way, real-time interactive communication between the patient and distant site physician or practitioner. For services furnished for purposes of diagnosis, evaluation, or treatment of a mental health disorder to a patient in their home, interactive telecommunications may include two-way, real-time audio-only communication technology if the distant site physician or practitioner is technically capable to use an interactive telecommunications system as defined in the previous sentence, but the patient is not capable of, or does not consent to, the use of video technology.
SOURCE: HI Med-Quest Memo No: QI-2306, CCS-2302, FFS23-04 (May 12, 2023). (Accessed Jun. 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 Jun. 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 Jun. 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 Jun. 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 Jun. 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 Jun. 2023).
Last updated 06/10/2023
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 Jun. 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 Jun. 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 Jun. 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 Jun. 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 Jun. 2023).
GEOGRAPHIC LIMITS
No Reference Found
TRANSMISSION FEE
No Reference Found
