Last updated 03/22/2022
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 Mar. 2022).
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. 80 (Mar. 2022) & MedQuest Memo, Reimbursement for Procedures Related to FFS Teledentistry Services, No. 19-01, Mar. 13, 2019 & Med-QUEST Memo 20-03. (Accessed Mar. 2022).
Last updated 03/22/2022
Live Video
POLICY
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(b). (Accessed Mar. 2022).
Hawaii Medicaid will reimburse for live video, as long as it “includes audio and video equipment, permitting real-time consultation among the patient, consulting practitioner and referring practitioner.”
SOURCE: Code of HI Rules 17-1737-51.1(c). (Accessed Mar. 2022).
Approval of Hawaii’s 2017 State Plan Amendment for telehealth services. Provides direction on billing for live video and store-and-forward services and types of services covered. Retroactive to January 1, 2017.
SOURCE: QI-2139 Tele-Health Law (Act 226, SLH 2016) Implementation/FFS 21-15 (Replaces QI-1702A/FFS-1701A). (Accessed Mar. 2022).
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 Mar. 2022).
Dentistry
Eligible codes for reimbursement are listed in Attachment A. All claims for services provided through telehealth technology must be identified by the applicable teledentistry CDT code D9995 or D9996.
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. 82 (Jan. 2021)., HI Department of Human Services. Med-QUEST Division. Attachment A., HI MedQUEST Division, CTR 1901 Reimbursement for Procedures Related to FQHC Teledentistry Services. (Accessed Mar. 2022).
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).
SOURCE: HI Med-QUEST Memo QI-2028 (Jul. 21, 2020) & QI-2020 (Jun. 17, 2020), (Accessed Mar. 2022).
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 20-03 (Mar. 16, 2020), QI-2139 Tele-Health Law (Act 226, SLH 2016) Implementation (Replaces QI-1702A), (Accessed Mar. 2022).
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 Mar. 2022).
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 Mar. 2022).
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 Mar. 2022).
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. 80, 85 (Jan. 2021) & MedQuest Memo, Reimbursement for Procedures Related to FFS Teledentistry Services, No. 19-01, Mar. 13, 2019. (Accessed Mar. 2022).
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 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 Mar. 2022)
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 Mar. 2022).
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 Mar. 2022).
Approved state plan amendment authorizes HI Medicaid to remove geographic and originating site requirements.
SOURCE: HI State Plan Amendment 16-0004. (Accessed Mar. 2022).
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 helath care provider through telehealth. The originating site includes a patient’s residence.
SOURCE: HI Med-QUEST Memo 20-03. (Accessed Mar. 2022).
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 Mar. 2022). – 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 Mar. 2022).
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. 80 (Mar. 2022).
Federally Qualified Health Centers:
Services must be provided at a HRSA approved site or satellite.
The spoke (originating site) is the location where the patient is located whether accompanied or not by a helath care provider through telehealth. The originating site includes a patient’s residence.
SOURCE: HI Med-QUEST Memo 20-03. (Accessed Mar. 2022).
FACILITY/TRANSMISSION FEE
No Reference Found
Last updated 03/22/2022
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, they should also be reimbursing for store-and-forward and remote patient monitoring, however CCHP has yet to find any documentation from Hawaii Medicaid that they are reimbursing for these modalities.
Last updated 03/25/2022
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 Mar. 2022).
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 Mar. 2022).
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 Mar. 2022).
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. 80 (Jan 2021) (Accessed Mar. 2022).
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. 6. (Accessed Mar. 2022).
GEOGRAPHIC LIMITS
No Reference Found
TRANSMISSION FEE
No Reference Found
