Hawaii Med-QUEST

MedicaidHI

ABA billing requirements · Source: Hawaii Medicaid — ABA Services Coverage (HB 1670 pending)

Medium confidence

Verified 2026-03-01

1 active policy alert

Hawaii proposes eliminating age 13 ABA coverage cap and $25,000 annual benefit limitEffective 2026-07-01

Hawaii HB 1670 proposes eliminating the current state law that limits ABA coverage mandates to individuals aged 13 and younger, and removes the $25,000 annual benefit limit. If enacted, Hawaii would join the majority of states with coverage extending to age 18 or 21.

Authorization Requirements

Requires prior auth Yes

Initial auth duration12 months

Renewal auth duration12 months

Submission deadlineN/A

Unit tracking cadenceTotal

Requires FBA Yes

Diagnostic eval validityN/A

Re-eval cadenceN/A

Documentation Requirements

Parent signatures required Yes

Start/stop times required Yes

Treatment plan componentsBaseline data, Target behaviors, Methods

Progress summary cadenceEvery 6 months

Policy Notes

Policy is from 2002. Children up to age 21 have no limits on medically necessary services. Adults have limited benefits. Outpatient psychotherapy is limited to 24 one-hour visits per 12-month period. Psychological testing is limited to 6 hours per 12-month period. Group therapy is limited to one visit per day for recipients 21 or older, with sessions not exceeding two hours and groups of 4-10 patients. Inpatient hospital days are limited to 30 days per calendar year.

CPT & Modifier Rules

CPT rules require a free account

View H-codes, modifiers, unit limits, and billing restrictions for Hawaii Med-QUEST.

Official policy source:Hawaii Medicaid — ABA Services Coverage (HB 1670 pending)

Track policy changes for Hawaii Med-QUEST

Get instant alerts when Hawaii Med-QUEST updates their ABA billing requirements. Watch this payor and never miss a policy change.

Watch this payor — free Browse all 192 payors

Data last verified: 2026-03-01 · Confidence: Medium · See our methodology

Inaccurate data? Sign in to submit a correction