Hawaii SB513/HB675 has passed which authorizes pharmacists to counsel, prescribe and dispense self-administered hormonal contraceptive supplies to patients regardless of a previous prescription, subject to specified education and procedural requirements and enables pharmacists to be reimbursed for prescribing and dispensing contraceptive supplies. Dispensing of oral contraceptives will continue to be covered under the member’s drug rider. This mandate does not apply to EUTF/HSTA or Medicare plans.
Pharmacist conditions:
- The pharmacist must be certified to prescribe contraceptives.
- The pharmacist must meet certain requirements, including:
- Providing a self-screening risk assessment tool that the patient must complete.
- Referring the patient to their PCP (or physician, if appropriate).
- Providing patients with a written record of the contraceptive prescribed and dispensed.
Reimbursement will follow the CPT code and fee chart below.
| CPT Code and Modifier | Description | Fee |
|---|---|---|
| 99201 with modifier 33* | Office/outpatient visit new, typically 10 minutes | $49.30 |
| 99202 with modifier 33* | Office/outpatient visit new, typically 20 minutes | $69.85 |
| 99211 with modifier 33* | Office/outpatient visit established, typically 5 minutes | $28.60 |
| 99212 with modifier 33* | Office/outpatient visit established, typically 10 minutes | $41.20 |
*Modifier 33 Preventive Services
Effective January 1, 2020, HMSA’s systems will be set up to accept claims dated back to July 1, 2017 for Commercial Plans (not including state plans).
Quest Integration will be set up in HMSA’s systems by April 1, 2020.
For general billing instructions, please go to CMS 1500 Claim Form – General Instructions. Fill out the CMS 1500 Claim Form (version 02-12) including section 24. A, B, D, E, F, G, and J.
Additional billing instructions: For pharmacists that have both a specialty pharmacist legacy ID and a par medical legacy ID, submit claims using the specialty pharmacist legacy ID (Specialty 127).
This service is not covered if the member has one of the following EUTF coverage codes:
- 449 – HSTA VB retirees WITHOUT Medicare.
- 563 – EUTF retirees WITH Medicare coverage.
- 667 – EUTF retirees WITHOUT Medicare coverage.
- 668 – HSTA VB retirees WITH Medicare coverage (as of 1/1/2019).
- X-G – EUTF Active HMO
- 693 – HSTA Active 80/20
- 823 – HSTA Active 90/10
- 852 – EUTF Active 75/25
- 690 – EUTF Active 80/20
- 562 – EUTF Active 90/10
Please be sure to use the most up-to-date industry-standard procedure, revenue, and diagnosis codes from the current CPT ®'', HCPCS Level II, and ICD-10-CM manuals, as recommended by the American Medical Association (AMA), the Centers for Medicare & Medicaid Services (CMS), and the American Hospital Association.
** Codes may not be all inclusive as the AMA and CMS code updates may occur more frequently.
Revision History
| Date | Nature of Revision |
|---|---|
| 08/03/2026 | Migrated to new platform.
|