Haw. Code R. § 17-1739.1-6.1 - Hawaii Medicaid fee schedule

(a) Payment to providers of medical care who are individual practitioners, including doctors of medicine, dentists, podiatrists, psychologist, osteopaths, optometrists, and other individuals providing services, shall be based upon the Hawaii Medicaid fee schedule.

(b) Payment for noninstitutional items and services, with the exception of prescribed drugs and EPSDT services, shall be based on the Hawaii Medicaid fee schedule. These items and services include, but are not limited to:

(1) Laboratory services;

(2) X-ray services;

(3) Physician services;

(4) Podiatric services;

(5) Optometric services;

(6) Other practitioner services including nurse midwife, pediatric nurse practitioner, advanced practice registered nurse in behavioral health, and licensed social worker in behavioral health;

(7) Dental Services (including dentures);

(8) Physical therapy;

(9) Occupational therapy;

(10) Services for persons with speech, language, and hearing disorders (exception: There shall be a flat rate for hearing evaluations.);

(11) Durable medical equipment, except eye glass frames and hearing aides;

(12) Medical supplies;

(13) Sleep services;

(14) Other services specified by the department.

(c) Providers who are visiting consultants to the neighbor islands may be reimbursed travel charges on the condition that an addendum to their provider agreement is submitted with the following information for approval by the department:

(1) The neighbor island to be visited;

(2) Frequency of visits; and

(3) Location where individuals are to be seen.

(d) Reimbursements may be made to providers who are visiting consultants as follows:

(1) $8 per patient visit; and

(2) An additional $7 per patient visit if hospital charges for supplies and equipment are assessed to the visiting consultant. Justification shall be required on the individual claim form when requesting this additional fee.

Notes

Haw. Code R. § 17-1739.1-6.1

[Eff 05/10/03] (Auth: HRS § 346-59) (Imp: 42 C.F.R. §§405.502, 405.503, 447.10)