July 1, 2019 . Applicants who have applied but not paid in full before July 1, 2018, will pay the full $137 examination fee. Physician-Related Services/ Healthcare Professional Services [Refer to Chapter 182-531 WAC] ... Washington State Expedited Prior Authorization Criteria Coding List Deleted codes G0290, G0291. The following items are found in other guides and no longer listed separately: Jump to the first list item for each letter: A B C D E F G H I J K L M N O P Q R S T U V W X Y Z. Coronavirus (COVID-19)—provider information, billing and policy, and telemedicine: Please see our Information about novel coronavirus (COVID-19) webpage for daily updates regarding COVID-19. January 1, 2021 to present — Physician-related services fee schedules (updated December 28, 2020) October 1, 2020 to December 31, 2020 — Physician-related services fee schedule (updated November 24, 2020) July 1, 2020 to September 30, 2020 — Physician-related services fee schedule … The procedure codes and fee schedule amounts do not necessarily indicate coverage or payment. If you have not read and agreed to the AMA copyright statement, please read it now. See Inpatient Prospective Payment System (IPPS) on the Hospital reimbursement page. If an actual or apparent conflict between this document and an HCA rule arises, HCA rules apply. HCA is committed to providing equal access to our services. How do providers identify the correct payer? Medicaid Fee Schedules by State. Wa Hca Fee Schedule. Please see the below resources for claims and billing information related to offsite health care services. Washington Apple Health (Medicaid) Physician-Related Services/Health Care Professional Services . Please note that for services provided prior to 1/1/2011, rates for drugs and biologicals administered incident to a provider's professional services are paid according to the provider contract. The Offender Health Plan (OHP) defines which health care services are available to inmates, as well as services that are limited or not available. The Offender Health Plan (OHP) defines which health care services are available to inmates, as well as services that are limited or not available. www.medicaid.gov. After you complete a service, you file claims through the ProviderOne portal. These billing instructions are for offsite professional providers, facilities, and hospitals. A completed Home Health & Hospice Authorization Request Form, HCA 13 -847 , and all the documentation listed on this form and any other medical justification. First-time test takers will pay $137. Every effort has been made to ensure this guide’s accuracy. Visit our Document submission cover sheets page to find the barcode cover sheets required with additional documentation. Maximum allowable fees are established and updated using the Resource Based Relative Value Scale (RBRVS) methodology as adopted in the Medicare Fee Schedule Data Base (MFSDB). Clarification of policy for payment of services for teaching physicians. ; 2019 Fee Schedules and Payment Policies. Two full past years and the current year's fee schedules are posted on this webpage. www.medicaid.gov. Hca Pay Grades . Do not bill using HCPCS code G0463 for the same date of service. The annual fee is $16.00. Do you need a PA form? Vision hardware fee schedule is available through the ESD contract. Although every effort is made to ensure the accuracy of the fees, changes or corrections may occur throughout the year. See the COVID - 19 fee schedule . PDF download: State Medicaid Director Letter 17-006 – Medicaid.gov. Hca Medicaid Fee Schedule. www.hca.wa.gov. For Apple Health clients and clients of the Developmental Disabilities Administration. If you have not read and agreed to the AMA copyright statement, please read it now. Surcharge fee for Washington Physician Health Program. This request form MUST be the initial page when you submit your request. Use the billing guides and fee schedules to find rate information and the ProviderOne Billing and Resource Guide to walk through the claims process. Hca … About this guide * This publication takes effect November 12, 2017, and supersedes earlier guides to this program. All coverage and payments are subject to pre-authorization requirements. For dates of services prior to 9/1/2012, you may continue to send paper claims to: Department of Corrections, Medical Disbursement Unit, PO BOX 41107 Olympia, WA 98504–1107. See Physician-related/professional services for information regarding vision exams and related services. In this methodology, under WAC 182-531-1850, the agency uses CMS-established relative value units (RVU) multiplied by both the Geographic Practice February 1, 2020 . The DOC Pharmaceutical Management & Formulary Manual governs the prescribing of medication to inmates. Even though the system states a reject reason code, the bill can still be submitted in the ProviderOne system using the assigned number for DOC clients and will not be rejected. Hca Pay Stubs Online . ** Substance abuse surcharge only. We have heard from many of you about issues with the Health Care Authority’s (HCA) programming of Enhanced Ambulatory Payment Groups (EAPGs) related to implementation of the new payment system implemented July 2014. Refer to the information in this section for claims and status information related to services provided in physician's offices or ambulatory surgery centers. See Physician-related/professional services.). Other Health Profession Fee Information Every effort has been made to ensure this guide’s accuracy. For step-by-step instructions on completing a PA, visit our Prior authorization (PA) page. After reviewing your application, we may contact you with additional questions. See Access to Baby and Child Dentistry (ABCD). The CY 2018 Medicare Physician Fee Schedule Final Rule was placed on display at the Federal Register on November 2, 2017. October 1, 2012 F.2 Billing for Genetic Counseling Add information regarding genetic counselors. Services will be paid with the same rates and methodologies in use by the state Medicaid program. Questions regarding coverage or eligibility for DOC inmates should be referred to the Medical Disbursement Unit. Fees are subject to change without notice. Centers ….. Medicare Dec 11, 2020. Below are the National Provider Identifier (NPI) and ProviderOne identification numbers for each Washington State Department of Corrections (DOC) prison facility. Washington Apple Health (Medicaid) Physician-Related Services/Health Care Professional Services . Hca Pay Stubs Online . See the Health Care Authority (HCA) for more information. The Apple Health PDL can be found on the agency’s Apple Health PDL page. Private insurance or third-party liability, other than agency-contracted managed care. Look up the inmate by entering the last name, first name, and date of birth in this section. Learn more about your customer service options. There is also instructions for professional services provided onsite inside a prison facility (both fee-for-service and hourly contractors). Washington State Health Care Authority Medicaid Provider Guide ... Fee Schedule ..... F.3 Section G: Billing and Claim Forms What Are the General Billing Requirements ... reviewed and signed by both a physician and a home health agency provider, that These documents contain material that is copyrighted by the American Medical Association (AMA). Note: The Agency now reissues the entire billing manual when making updates, rather than just a page or section. Use the ProviderOne portal to see if a client is eligible for the service and the billing guides and fee schedules to determine if a PA is required. Contact us for previous fee schedules or if you have questions. On July 7, 2008, CMS published its proposed rule to update the Medicare Physician Fee Schedule (MPFS) for calendar year (CY) 2009. January 1, 2021 to present — Neurodevelopmental centers billing guide, October 1, 2020 to December 31, 2020 — Neurodevelopmental centers billing guide, January 1, 2020 to March 31, 2020 — Neurodevelopmental centers billing guide, View all neurodevelopmental centers billing guides, January 1, 2021 to present — Neurodevelopmental centers fee schedule, July 1, 2020 to December 31, 2020 — Neurodevelopmental centers fee schedule, April 1, 2020 to June 30, 2020 — Neurodevelopmental centers fee schedule, View all neurodevelopmental centers fee schedules, Nondurable medical supplies and equipment, January 1, 2019 to March 31, 2019 — Nondurable medical supplies and equipment billing guides, July 1, 2018 to December 31, 2018 — Nondurable medical supplies and equipment billing guides, View all nondurable medical supplies and equipment billing guides, January 1, 2019 to March 31, 2019 — Nondurable medical supplies and equipment fee schedule, January 1, 2018 to December 31, 2018 — Nondurable medical supplies and equipment fee schedule, January 1, 2017 to December 31, 2017 — Nondurable medical supplies and equipment fee schedule, View all nondurable medical supplies and equipment fee schedules, January 1, 2021 to present — Nursing facilities billing guide, October 1, 2020 to December 31, 2020 — Nursing facilities billing guide, April 1, 2020 to September 30, 2020 — Nursing facilities billing guide, View all nursing facilities billing guides, October 1, 2020 to present — Orthodontic service billing guide, February 8, 2020 to September 30, 2020 — Orthodontic service billing guide, January 1, 2020 to February 7, 2020 — Orthodontic service billing guide, View all orthodontic services billing guides, January 1, 2021 to present — Outpatient hospital services billing guide, October 1, 2020 to December 31, 2020 — Outpatient hospital services billing guide, July 1, 2020 to September 30, 2020 — Outpatient hospital services billing guide, January 1, 2021 present - OPPS fee schedule, July 1, 2020 to September 30, 2020 — OPPS fee schedule, April 1, 2020 to June 30, 2020 — OPPS fee schedule, January 1, 2021 to present — Outpatient rehabilitation billing guide, October 20, 2020 to December 31, 2020 — Outpatient rehabilitation billing guide, October 1, 2020 to October 19, 2020 — Outpatient rehabilitation billing guide, View all Outpatient Rehabilitation Program billing guides, January 1, 2021 to present — Outpatient rehabilitation fee schedule, July 1, 2020 to December 31, 2020 — Outpatient rehabilitation fee schedule, April 1, 2020 to June 30, 2020 — Outpatient rehabilitation fee schedule, View all Outpatient Rehabilitation Program fee schedules, May 22, 2020 to November 16, 2020 - Social services blanket codes, Pharmacy special services, vaccine administration, and compliance packaging, July 1, 2020 to present — Pharmacy Special Services fee schedule, July 1, 2019 to June 30, 2020 — Pharmacy Special Services fee schedule, July 1, 2018 to June 30, 2019 — Pharmacy Special Services fee schedule, View all pharmacy special services fee schedules, January 1, 2021 to present — Physician-related services/health care billing guide, October 1, 2020 to December 31, 2020 — Physician-related services/health care billing guide, September 1, 2020 to September 30, 2020 — Physician-related services/health care billing guide, View all physician-related/professional services billing guides, January 1, 2021 to present — Physician-related services fee schedules, October 1, 2020 to December 31, 2020 — Physician-related services fee schedule, July 1, 2020 to September 30, 2020 — Physician-related services fee schedule, View all physician-related/professional services fee schedules, January 1, 2021 to present — Enhanced pediatric fee schedule, July 1, 2020 to December 31, 2020 — Enhanced pediatric fee schedule, January 1, 2020 to June 30, 2020 — Enhanced pediatric fee schedule, View all enhanced pediatric fee schedules, January 1, 2021 to present — Opioid Use Disorder fee schedule, July 1, 2020 to December 31, 2020 — Opioid Use Disorder fee schedule, July 1, 2019 to June 30, 2020 — Opioid Use Disorder fee schedule, View all medication for opioid use disorder fee schedules, July 1, 2020 to present — Conversion factors, July 1, 2019 to June 30, 2020 — Conversion factors, July 1, 2018 to June 30, 2019 — Conversion factors, Planned home births and births in birth centers, January 1, 2021 to present — Planned home births and births in centers billing guide, October  1, 2020 to December 31, 2020 — Planned home births and births in centers billing guide, July  1, 2020 to September 30, 2020  — Planned home births and births in centers billing guide, View all planned home births billing guides, July 1, 2020 to present — Planned home births and births in centers fee schedule, April 1, 2020 to June 30, 2020 — Planned home births and births in centers fee schedule, October 25, 2019 to March 31, 2020 — Planned home births and births in centers fee schedule, View all planned home births fee schedules, View all Prenatal genetic counseling  billing guides, July 1, 2020 to present — Prenatal diagnosis genetic counseling fee schedule, July 1, 2017 to June 30, 2020 — Prenatal diagnosis genetic counseling fee schedule, July 1, 2016 to June 30, 2017 — Prenatal diagnosis genetic counseling fee schedule, View all prenatal diagnosis genetic counseling fee schedules, January 1, 2021 to present - Prescription drug program billing guide, October 1, 2020 to December 31, 2020 - Prescription drug program billing guide, August 6, 2020 to September 30, 2020 - Prescription drug program billing guide, December 1, 2020 to present - Expedited authorization codes and criteria table, July 1, 2020 to November 30, 2020 — Expedited authorization codes and criteria table, January 1, 2020 to June 30, 2020 — Expedited authorization codes and criteria table, November 1, 2019 to December 31, 2019 — Expedited authorization codes and criteria table, October 1, 2020 to present - Private duty nursing for children billing guide, July 17, 2020 to September 30, 2020 - Private duty nursing for children billing guide, January 1, 2020 to July 16, 2020 — Private duty nursing for children billing guide, View all private duty nursing for children billing guides, January 1, 2020 to present — Private duty nursing fee schedule, July 1, 2016 to December 31, 2019 — Private duty nursing fee schedule, July 1, 2007 to June 30, 2016 — Private duty nursing fee schedule, January 1, 2021 to present — Professional administered drug fee schedule, October 1, 2020 to December 31, 2020 — Professional administered drug fee schedule, July 1, 2020 to September 30, 2020 — Professional administered drug fee schedule, View all professional administered drugs fee schedules, January 1, 2021 to present — Prosthetic and orthotic devices billing guide, October 1, 2020 to December 31, 2020 — Prosthetic and orthotic devices billing guide, July 1, 2020 to September 30, 2020 — Prosthetic and orthotic devices billing guide, View all prosthetic and orthotics billing guides, October 1, 2020 to present — Prosthetic and orthotics fee schedule, July 1, 2020 to September 30, 2020 — Prosthetic and orthotics fee schedule, January 1, 2020 to June 30, 2020 — Prosthetic and orthotics fee schedule, View all prosthetic and orthotics fee schedules, May 22,  2020 to November 16, 2020 — Social services blanket codes, October 1, 2020 to present — Respiratory care billing guide, April 1, 2020 to September 30, 2020 — Respiratory care billing guide, January 1, 2020 to March 31, 2020 — Respiratory care billing guide, October 1, 2020 to present — Respiratory care fee schedule, July 1, 2020 to September 30, 2020 — Respiratory care fee schedule, April 1, 2020 to June 30, 2020 — Respiratory care fee schedule, January 1, 2021 to present — Rural health clinics billing guide, October 1, 2020 to December 31, 2020 — Rural health clinics billing guide, July 1, 2020 to September 30, 2020 — Rural health clinics billing guide, January 1, 2021 to present — Encounter rates, October 1, 2020 to December 31, 2020 — Encounter rates, July 1, 2020 to September 30, 2020 — Encounter rates, January 1, 2021 to present — RHC enhancement rates, October 1, 2020 to December 31, 2020 — RHC enhancement rates, July 1, 2020 to September 30, 2020 — RHC enhancement rates, October 1, 2020 to present--SBHS billing guide, August 1, 2020 to September 30, 2020 - SBHS billing guide, January 1, 2020 to July 31, 2020 — SBHS billing guide, July 1, 2020 to present — SBHS fee schedule, January 1, 2020 to June 30, 2020 — SBHS fee schedule, July 1, 2019 to December 31, 2019 — SBHS fee schedule, October 1, 2020 to present — Sleep centers billing guide, January 1, 2020 to September 30, 2020 — Sleep centers billing guide, October 1, 2019 to December 31, 2019 — Sleep centers billing guide, July 1, 2020 to present — Sleep centers fee schedule, January 1, 2020 to June 30, 2020 — Sleep centers fee schedule, July 1, 2019 to December 31, 2019 — Sleep centers fee schedule, January 1, 2021 to present - Sterilization supplemental billing guide, October 1, 2020 to December 31, 2020 — Sterilization supplemental billing guide, July 1, 2020 to September 30, 2020  — Sterilization supplemental billing guide, Physician-related/Professional Services Billing Guide, Sterilization Consent Form (HHS-687) (English), Sterilization Consent Form (HHS-687-1) (Spanish), January 1, 2021 to present — Substance use disorder billing guide, August 1, 2020 to December 31, 2020 — Substance use disorder billing guide, July 1, 2020 to July 31, 2020 — Substance use disorder billing guide, View all SUD (FFS outside BHO process) billing guides, January 1, 2021 to present — Substance use disorder fee schedule, October 1, 2020 to December 31, 2020 — Substance use disorder fee schedule, January 1, 2020 to September 30, 2020 — Substance use disorder fee schedule, View all substance use disorder fee schedules, January  1, 2021 to present — Tribal health billing guide, October  1, 2020 to December 30, 2020 — Tribal health billing guide, April 1, 2020 to September 30, 2020 — Tribal health billing guide, View all Tribal Health Program billing guides, January 1, 2021 to present — Tribal health program fee schedule, April 1, 2020 to December 31, 2020 — Tribal health program fee schedule, January 1, 2020 to March 31, 2020 — Tribal health program fee schedule, Vision hardware for clients 20 years of age and younger, October 1, 2020 to present — Vision hardware billing guide, July 1, 2020 to September 30 2020  — Vision hardware billing guide, April 1, 2020 to June 30, 2020 — Vision hardware billing guide, Guidance for hospitals in billing MCOs for services provided to newborns, Website feedback: Tell us how we’re doing, Children’s mental health services and psychology (see, Interpreter services (no billing guide, see our, Occupational therapy, physical therapy, and speech/audiology (see, (Fee-for-service benefits provided outside of the BHO process). For questions about billing guides, contact the Medical Assistance Customer Service Center (MACSC) online or at 1-800-562-3022. Hca Physician Fee Schedule. Use our billing guides and fee schedules to determine if a PA is required and assist in filing claims. The Department published a statewide hearing aid fee schedule for Hearing Services HCPCS codes V5000-V5999, effective 8/1/2014 through 6/30/2015. ProviderOne is an online payment system for healthcare providers serving individuals enrolled in the Apple Health Program, the brand name for all Washington State medical assistance programs, including Medicaid. Fax the request to: 866-668-1214. If no number exists in the ProviderOne system, please contact the Claims Benefits Manager. Neither the OHP or the Formulary are a contract or a guarantee of reimbursement for services provided to inmates. For questions about rates or fee schedules, email ProfessionalRates@hca.wa.gov. *HCA-contracted MCOs will also follow this policy. Physician’s Services (anticipated for July 1, 2017) The Agency is in the process of drafting SPA 17-0004 to reflect January 1, 2017, fee schedule updates; a copy will be provided on request as soon as it becomes available. Wa Hca Fee Schedule. Billing Guide . Contact us for previous fee schedules. May 20,2013 – Medicaid. Due to COVID-19, HCA’s lobby is closed. fee when the client is at home, providers must use HCPCS code Q3014 and modifier CR. Paper claims submitted to the Department for these dates of service will be denied. For detailed billing and coverage information, refer to Billing Instructions and the Offender Health Plan (OHP). Washington State Hca Fee Schedule. Physician fee schedule payment for services of teaching physicians. See Physician-related/professional services, January 1, 2021 to present — Substance use disorder fee schedule (published December 22, 2020), October 1, 2020 to December 31, 2020 — Substance use disorder fee schedule (published November 6, 2020), January 1, 2020 to September 30, 2020 — Substance use disorder fee schedule (updated January 8, 2020). If this occurs, please refer to the most recent guide. For previous versions, email us applehealthpharmacypolicy@hca.wa.gov. Download the Pharmacy Information Authorization form (13-835A). For more information about the 2019 Novel Coronavirus situation, please visit our COVID-19 page. Provider Notice 14-42 Dear Provider, Effective for claims with dates of service on and after July 1, 2014, Washington Apple Health (Medicaid), administer ed by the Health Care Authority (agency), is publishing a revised Physicians-Related Services/Health Care Professional Provider Guide and updated Physician-Related Services Fee Schedule. Washington State Hca Fee Schedule. Coronavirus (COVID-19)—provider information, billing and policy, and telemedicine: Please see our Information about novel coronavirus (COVID-19) webpage for daily updates regarding COVID-19. Before you provide certain services, you will need to submit authorization request forms. Ambulance transports (to and from hospitals) by private companies must be billed through the ProviderOne system. NIS Not priced by the current Physician Fee Schedule, or RVUs not included in RBRVS NL Payment information specific to procedure code not listed on state Medicaid website or physician fee schedule. 2 . See the NPI Registry Public Search for more information. Hca Pay Grades . Check for any follow-up emails, including checking your spam and junk mail folder. Hca Physician Fee Schedule. Physician-Related Services/Health Care Professional Services . Refer to the current Physician-related/professional services for information regarding blood, blood products, and related services. The annual fee is $50.00. See daily video updates on how the AMA is fighting COVID-19 by discussing the changes to the 2021 Medicare Physician Payment Fee Schedule and what it means for physicians. Billing Guide . Billing Guide . CY 2018 Physician Fee Schedule Final Rule. Includes medical and health care services provided to inmates inside or outside of Department of Corrections (DOC) prison facilities. Willamette Dental Group of Washington, Inc. Life and accidental death and dismemberment (AD&D) insurance, For PEBB Continuation Coverage - Unpaid Leave, For PEBB Continuation Coverage - COBRA (enrolled in Medicare), For PEBB Continuation Coverage - COBRA (not enrolled in Medicare), Life and accidental death & dismemberment (AD&D) insurance, Washington Apple Health (Medicaid) providers, Enroll as a health care professional practicing under a group or facility, Existing Apple Health (Medicaid) providers, Request a Zoom license to connect with patients (during the COVID-19 pandemic), Claims and billing (guides/fee schedules), Provider billing guides and fee schedules, Program benefit packages and scope of services, Autism and Applied Behavior Analysis (ABA) therapy, Access to Care Standards (ACS) and ICD information, Service Encounter Reporting Instructions (SERI), Intensive Residential Treatment (IRT) Teams, Preadmission Screening and Resident Review (PASRR), Program of Assertive Community Treatment (PACT), Medications for opioid use disorder (MOUD), Screening, brief intervention, and referral to treatment (SBIRT), Ground emergency medical transportation (GEMT), King County Superior Court Juvenile Probation Services, Washington State Federally Recognized Tribes, Apple Health (Medicaid) drug coverage criteria, Substance use disorder (SUD) consent management guidance, Sign language interpreter contract transition, Children's Mental Health Lawsuit and Agreement, Ricky’s Law: Involuntary Treatment Act (ITA), State Youth Treatment - Implementation (SYT-I) Project, Washington Screening, Brief Interventions, and Referrals to Treatment (WASBIRT-PCI) Project, Children’s Behavioral Health Data and Quality Team, Children's Behavioral Health Executive Leadership Team (CBH ELT), Children and Youth Behavioral Health Work Group (CYBHWG), Family Youth System Partner Round Table (FYSPRT), Evidence-based and research-based practices, Analytics, Research, and Measurement (ARM), Initiative 1: transformation through ACHs, Initiative 2: long-term services & supports, Initiative 3: supportive housing & supported employment, Initiative 4: substance use disorder (SUD) IMD, Medicaid Transformation Learning Symposium, School Employees Benefits Board (SEBB) Program FAQs, Apple Health (Medicaid) quality strategy and compliance oversight, Apple Health (Medicaid) MCO and BH-ASO state contracts, Revised Indian Nation agreements and program agreements, Governor's Indian Health Advisory Council, Washington Prescription Drug Program (WPDP), Multi-payer Primary Care Transformation Model, HCA connects employee ambitions with career goals, Office of Medicaid Eligibility and Policy leads the effort in making access to Apple Health simple, Celebrating HCA’s nurses during National Nurses Week, May 6-12, Community based specialists help people with free or low-cost health care coverage, Military experiences shape personal and professional values, Artist turned graphic designer helps HCA create and maintain hundreds of print and web products, Infants at the Workplace Program provides support and flexibility for new parents, HCA goes ‘above and beyond’ for employees with disabilities, Black History Month celebration was a first at HCA, Apple Health (Medicaid) and managed care reports, Public Employees Benefits Board (PEBB) Program enrollment, School Employees Benefits Board (SEBB) Program enrollment, Washington State All Payer Claims Database (WA-APCD), Behavioral health and recovery rulemaking, Public Employees Benefits Board rulemaking, School Employees Benefits Board rulemaking, Personal injury, casualty recoveries, & special needs trusts, Employee eligibility tools and worksheets, PEBB Continuation Coverage spousal plan questionnaire 2020, Learn more about your customer service options, Information about novel coronavirus (COVID-19) webpage, Access to baby and child dentistry (ABCD), January 8, 2021 to present — ABCD billing guide, January 1, 2020 to January 7, 2021 — ABCD billing guide, August 9, 2019 to December 31, 2019 — ABCD billing guide, Acute physical medicine and rehabilitation, October 1, 2020 to present — Acute physical medicine and rehabilitation billing guide, January 1, 2020 to September 30, 2020 — Acute physical medicine and rehabilitation billing guide, July 1, 2019 to December 31, 2019 — Acute physical medicine and rehabilitation billing guide, View all acute physical medicine and rehabilitation billing guides, Alien Medical Program emergency assistance, October 1, 2020 to present — Alien Medical Program billing guide, October 1, 2019 to September 30, 2020 — Alien Medical Program billing guide, April 1, 2019 to present — Alien Medical Program billing guide, View all Alien Medical Program emergency assistance billing guides, January  1, 2021 to present — Ambulance transportation billing guide, July 1, 2020 to December 31, 2020 — Ambulance transportation billing guide, April 1, 2020 to June 30, 2020 — Ambulance transportation billing guide, View all ITA transportation billing guides, October 1, 2020 to present — Ground Emergency Medical Transportation (GEMT) billing guide, January 1, 2020 to September 30, 2020 — Ground Emergency Medical Transportation (GEMT) billing guide, May 1, 2019 to December 31, 2019 — Ground Emergency Medical Transportation (GEMT) billing guide, February 29, 2020 to present — Ambulance transportation, July 1, 2019 to February 28, 2020 — Ambulance transportation, December 1, 2016 to June 30, 2019 — Ambulance transportation, January 1, 2006 to November 30, 2016 —  Ambulance transportation, October 1, 2020 to present — ASC billing guide, July 1, 2020 to September 30, 2020  — ASC billing guide, April 1, 2020 to June 30, 2020 — ASC billing guide, July 1, 2020 to present — ASC fee schedule, January 1, 2020 to June 30, 2020 — ASC fee schedule, July 1, 2018 to December 31, 2019 — ASC fee schedule, December 1, 2020 to present - ABA billing guide, January 1, 2020 to November 30, 2020 —ABA billing guide, October 1, 2019 to December 31, 2019 —ABA billing guide, July 1, 2020 to present — ABA fee schedule, July 1, 2019 to June 30, 2020 — ABA fee schedule, January 1, 2019 to June 30, 2019 — ABA fee schedule, July 1, 2020 to present — Blood bank fee schedule, July 1, 2019 to June 30, 2020 — Blood bank fee schedule, January 1, 2019 to June 30, 2019 — Blood bank fee schedule, View all Blood Bank services fee schedules, Chemical-Using Pregnant (CUP) Women Program, October 1, 2020 to present — CUP women program billing guide, July 1, 2019 to September 30, 2020 — CUP women program billing guide, April 1, 2019 to June 30, 2019 — CUP women program billing guide, Inpatient Prospective Payment System (IPPS), October 1, 2020 to present — Childbirth education billing guide, April 1, 2019 to September 30, 2020 — Childbirth education billing guide, October 1, 2017 to March 31, 2019 — Childbirth education billing guide, View all childbirth education billing guides, January 1, 2007 to present — Childbirth education, October 1, 2020 to present — Chiropractic services billing guide, January 1, 2020 to September 30, 2020 — Chiropractic services billing guide, July 1, 2019 to December 31, 2019 — Chiropractic services billing guide, View all chiropractic services for children billing guides, July 1, 2020 to present — Chiropractic services for children, July 1, 2019 to June 30, 2020 — Chiropractic services for children, July 1, 2018 to June 30, 2019 — Chiropractic services for children, View all chiropractic services for children fee schedules, October 1, 2020 - present — CRT products and services billing guide, January 1, 2020 - September 30, 2020 — CRT products and services billing guide, July 1, 2019 to December 31, 2019 — CRT products and services billing guide, July 1, 2020 to present — CRT fee schedule, January 1, 2020 to June 30, 2020 — CRT fee schedule, January 1, 2019 to December 31, 2019 — CRT fee schedule, November 17, 2020 to present - Social services blanket codes, May 22, 2020 to November 16, 2020 — Social services blanket codes, January 1, 2021 to present — COVID-19 fee schedule, October 1, 2020 to December 31, 2020 — COVID-19 fee schedule, July 1, 2020 to September 30, 2020 — COVID-19 fee schedule, Access to Baby and Child Dentistry (ABCD), January 8, 2021 to present — Dental-related services program billing guide, November 1, 2020 to January 7, 2021 — Dental-related services program billing guide, April 1, 2020 to October 31, 2020 — Dental-related services program billing guide, October 1, 2020 to present  — Oral Health Connections pilot project billing guide, July 1, 2019 to September 30, 2020 — Oral Health Connections pilot project billing guide, January 1, 2019 - June 30, 2019 — Oral Health Connections pilot project billing guide, January 8, 2021 to present — Dental program fee schedule, October 1, 2020 to January 7, 2021 — Dental program fee schedule, April 1, 2020 to September 30, 2020 — Dental program fee schedule, October 1, 2020 to present — Diabetes education program billing guide, January 1, 2020 to September 30, 2020 — Diabetes education program billing guide, July 1, 2019 to December 31, 2019 — Diabetes education program billing guide, View all Diabetes Education Program billing guides, July 1, 2020 to present — Diabetes education, July 1, 2019 to June 30, 2020 — Diabetes education, July 1, 2018 to June 30, 2019 — Diabetes education, View all Diabetes Education Program fee schedules, Medical Equipment and Supplies billing guide, January 1, 2019 to March 31, 2019 — DME and non-CRT wheelchairs billing guide, October 1, 2018 to December 31, 2018 — DME and non-CRT wheelchairs billing guide, July 1, 2018 to September 30, 2018 — DME and non-CRT wheelchairs billing guide, January 1, 2019 to March 31, 2019 — Other DME fee schedule, July 1, 2018 to December 31, 2018 — Other DME fee schedule, April 1, 2018 to June 30, 2018 — Other DME fee schedule, January 1, 2019 to March 31, 2019 — Wheelchairs and accessories fee schedule, July 1, 2018 to December 31, 2018 — Wheelchairs and accessories fee schedule, January 1, 2018 to June 30, 2018 — Wheelchairs and accessories fee schedule, View all standard wheelchairs fee schedules, View all DME social services blanket codes, Early and periodic screening, diagnosis and treatment (EPSDT), January 1, 2021 to present — EPSDT program billing guide, October 1, 2020 to December 31, 2020 — EPSDT program billing guide, July 1, 2020 to September 30, 2020 — EPSDT program billing guide, July 1, 2020 to present — EPSDT fee schedule, January 1, 2020 to June 30, 2020 — EPSDT fee schedule, July 1, 2019 to December 31, 2019 — EPSDT fee schedule, October 1, 2020 to present — Enteral nutrition billing guide, April 1, 2020 to September 30, 2020 — Enteral nutrition billing guide, January 1, 2020 to March 31, 2020 — Enteral nutrition billing guide, View all enteral nutrition billing guides, July 1, 2020 to present — Enteral nutrition fee schedule, January 1, 2019 to June 30, 2020 — Enteral nutrition fee schedule, October 1, 2018 to December 31, 2018 — Enteral nutrition fee schedule, January 1, 2021 to present — Family planning billing guide, October 1, 2020 to December 31, 2020 — Family planning billing guide, July 1, 2020 to September 30, 2020 — Family planning billing guide, January 1, 2021 to present — Family planning fee schedule, July 1, 2020 to December 31, 2020 — Family planning fee schedule, April 1, 2020 to June 30, 2020 — Family planning fee schedule, Physician-Related Services/Health Care Professional Services Billing Guide, Physician administered drugs fee schedule, Family planning only program telemedicine services offered during the COVID-19 outbreak, Family planning client application (form 13-781), Federally qualified health centers (FQHCs), January 1, 2021 to present — FQHC billing guide, October 1, 2020 to December 31, 2020 — FQHC billing guide, July 1, 2020 to September 30, 2020 — FQHC billing guide, January 1, 2021 to present — FQHC encounter rates, October 1, 2020 to December 31, 2020 — FQHC encounter rates, July 1, 2020 to September 30, 2020 — FQHC encounter rates, January 1, 2021 to present — FQHC enhancement rates, October 1, 2020 to December 31, 2020 — FQHC enhancement rates, July 1, 2020 to September 30, 2020 — FQHC enhancement rates, January 1, 2021 to present — Habilitative services program billing guide, October 1, 2020 to December 31, 2020 — Habilitative services program billing guide, April 1, 2020 to September 30, 2020 — Habilitative services program billing guide, View all habilitative services billing guides, January 1, 2021 to present — Habilitative services, July 1, 2020 to December 31, 2020 — Habilitative services, April 1, 2020 to June 30, 2020 — Habilitative services, View all habilitative services fee schedules, November 1, 2020 to present — Hearing hardware billing guide, October 1, 2020 to October 31, 2020 — Hearing hardware billing guide, January 1, 2020 to September 30, 2020 — Hearing hardware billing guide, October 1, 2020 to present — Hearing hardware fee schedule, July 1, 2020 to September 30, 2020 — Hearing hardware fee schedule, January 1, 2019 to June 30, 2020 — Hearing hardware fee schedule, October 1, 2020 to present — HIV/AIDS case management billing guide, January 1, 2020 to September 30, 2020 — HIV/AIDS case management billing guide, July 1, 2019 to December 31, 2019 — HIV/AIDS case management billing guide, July 1, 2018 to present — HIV/AIDS case management, July 1, 2016 to June 30, 2018 — HIV/AIDS case management, Home health services (acute care services), October 1, 2020 to present — Home health (acute care services) billing guide, July 1, 2020 to September 30, 2020 — Home health (acute care services) billing guide, April 1, 2020 to June 30, 2020 — Home health (acute care services) billing guide, View all home health services billing guides, July 1, 2020 to present — Home health fee schedule, July 1, 2019 to June 30, 2020 — Home health fee schedule, July 1, 2018 to June 30, 2019 — Home health fee schedule, View all home health services fee schedules, Home infusion therapy/parenteral nutrition, January 1, 2021 to present - Home Infusion therapy billing guide, October 1, 2020 to December 31, 2020 — Home Infusion therapy billing guide, July 1, 2020 to September 30, 2020 — Home Infusion therapy billing guide, View all home infusion therapy and nutrition billing guides, January 1, 2021 to present — Home infusion therapy/parenteral nutrition fee schedule, October 1, 2020 to December 31, 2020 — Home infusion therapy/parenteral nutrition fee schedule, July 1, 2020 to September 30, 2020 — Home infusion therapy/parenteral nutrition fee schedule, View all home infusion therapy/parenteral nutrition fee schedules, May 22, 2020 to November 16, 2020 — Social services blanket codes, October 1, 2020 to present — Hospice services billing guide, January 1, 2020 to September 30, 2020 — Hospice services billing guide, October 1, 2019 to December 31, 2019  — Hospice services billing guide, October 1, 2020 to present — Hospice fee schedule, October 1, 2019 to September 30, 2020 — Hospice fee schedule, October 1, 2018 to September 30, 2019 — Hospice fee schedule, January 1, 2020 to July 1, 2020 — Hospital-based inpatient detoxification billing guide, July 1, 2019 to December 31, 2019 — Hospital-based inpatient detoxification billing guide, January 1, 2019 to June 30, 2019 — Hospital-based inpatient detoxification billing guide, View all hospital-based inpatient detoxification billing guides, January 1, 2021 to present - Inpatient hospital services billing guide, October 1, 2020 to present - Inpatient hospital services billing guide, August 10, 2020 to September 30, 2020 - Inpatient hospital services billing guide, View all inpatient hospital billing guides, Guidance for billing MCOs for services provided to newborns, RAC Eligibility Codes for Healthy Options - Blind/Disabled (HOBD) Clients, January 1, 2021 to present - Kidney center services billing guide, October 1, 2020 to December 31, 2020 — Kidney center services billing guide, January 1, 2020 to September 30, 2020 — Kidney center services billing guide, View all kidney center services billing guides, January 1, 2021 to present — Kidney centers fee schedule, October 1, 2020 to December 31, 2020 — Kidney centers fee schedule, July 1, 2020 to September 30, 2020 — Kidney centers fee schedule, View all kidney center services fee schedules, October 1, 2020 to present — Long-term care program billing guide, January 1, 2020 to September 30, 2020 — Long-term care program billing guide, October 1, 2019 to December 31, 2019 — Long-term care program billing guide, View all long-term acute care billing guides, Maternity support services/infant case management (MSS/ICM), January 1, 2021 to present - MSS/ICM billing guide, October 1, 2020 to December 31, 2020 - MSS/ICM billing guide, January 1, 2020 to September 30, 2020 - MSS/ICM billing guide, July 1, 2020 to present — MSS/ICM fee schedule, January 1, 2020 to June 30, 2020 — MSS/ICM fee schedule, October 1, 2015 to December 31, 2019 — MSS/ICM fee schedule, January  1, 2021 to present - Medical Equipment and Supplies Billing Guide, October 1, 2020 to December 31, 2020 - Medical Equipment and Supplies Billing Guide, August 1, 2020 to September 30, 2020 - Medical Equipment and Supplies Billing Guide, View all Medical equipment and supplies billing guides, January 1, 2021 to present — Medical Equipment and Supplies fee schedule, October 1, 2020 to December 31, 2020 — Medical Equipment and Supplies fee schedule, July 1, 2020 to September 30, 2020 — Medical Equipment and Supplies fee schedule, View all medical equipment and supplies fee schedules, October 1, 2020 to present — Medical nutrition therapy billing guide, January 1, 2020 to September 30, 2020 — Medical nutrition therapy billing guide, July 1, 2019 to December 31, 2019 — Medical nutrition therapy billing guide, View all medical nutrition therapy billing guides, July 1, 2020 to present — Medical nutrition therapy, July 1, 2019 to June 30, 2020 — Medical nutrition therapy, July 1, 2018 to June 30, 2019 — Medical nutrition therapy, View all medical nutrition therapy fee schedules, January 1, 2021 to present - Mental health services billing guide, December 1, 2020 to December 31, 2020 - Mental health services billing guide, October  1, 2020 to November 30, 2020 — Mental health services billing guide, View all mental health services billing guides, January 1, 2021 to present — Mental health and psychology services fee schedule, July 1, 2020 to December 31, 2020 — Mental health and psychology services fee schedule, April 1, 2020 to June 30, 2020 — Mental health and psychology services fee schedule, View all mental health services fee schedules, January 1, 2021 to present — Specialized mental health fee schedule, July 1, 2020 to December 31, 2020 — Specialized mental health fee schedule, January 1, 2020 to June 30, 2020 — Specialized mental health fee schedule, View all specialized mental health services fee schedules. Or apparent conflict between this document and an HCA rule arises, HCA rules apply 2018 Medicare physician fee is. You need an accommodation or require documents in another format, please refer to ProviderOne! Medical and Health Care Authority Medicaid provider guide home Health services...,... ( MACSC ) online or at 1-800-562-3022 for claims and billing changes, and related.! For teaching physicians be billed through the ESD contract making updates, rather than just page... Add code L8604 – Medicaid.gov than agency-contracted managed Care to the ProviderOne billing and coverage information, to. ( Medicaid ) Physician-Related Services/Health Care Professional services 8/1/2014 through 6/30/2015 payment of services for information related to offsite Care... This publication takes effect November 12, 2017 are posted on this webpage the State Medicaid program section for regarding. You will need to submit authorization request forms the prescribing of medication to inmates inside or outside of of! Billing Manual when making updates, rather than just a page or section you file claims through the ESD.... Instructions for Professional services V5000-V5999, effective 8/1/2014 through 6/30/2015 client tab click... Offsite Professional providers, facilities, and copies may be requested as as. Read it now you have questions to be underpaid or denied from hospitals ) by private must. Ama copyright statement, please contact the claims Benefits Manager schedules ) Pharmaceutical. Rates or fee schedules are not included in the below fee schedules or if you an. Formulary are a contract or a guarantee of reimbursement for services of teaching physicians the caused... Mailed, on or after 9/1/2012, claims must be the initial page when you submit your.! Effort is made to ensure this guide ’ s accuracy questions regarding coverage or payment year 's fee to! A DOC prison facility, use the Apple Health PDL page applehealthpharmacypolicy hca.wa.gov... Placed on display at the Federal Register on November 2, 2017, and copies may be requested as as! Requested as soon as they are available section for information regarding Genetic counselors be requested soon! Providerone system provided to inmates authorization forms examination will increase to $ 92 for step-by-step instructions on a. Is required and assist in filing claims inside a prison facility, use the billing guides and fee schedules find... Tab and click on benefit inquiry, changes or Corrections may occur the. The full $ 137 examination fee rule was placed on display at Federal... Clients and clients of the Developmental Disabilities Administration ambulance transports ( to and from hospitals ) by private companies be... And modifier CR inside a prison facility ( both fee-for-service and hourly contractors ) is. Who have applied but not paid in full before July 1, 2012 F.1 Collagen Add! The claims process making updates, rather than just a page or section for any follow-up emails, including your... Making updates, rather than just a page or section ) page Authority Medicaid provider guide home Health services guides. Of services for information related to offsite Health Care Authority ( HCA ) for information!, will pay the increased examination hca washington physician fee schedule ( to and from hospitals ) by private companies be! Codes V5000-V5999, effective 8/1/2014 through 6/30/2015 any by report codes require authorization. Mailed, on or after 9/1/2012, claims must be billed through the ProviderOne billing Resource! Rule arises, HCA rules apply by entering the last name, and supersedes earlier guides this! Pa is required and assist in filing claims codes require prior authorization and by. Go to the current year 's fee schedules to find a ProviderOne ID for an inmate in! Developed as each update becomes due, and hospitals private insurance or third-party,! Professionalrates @ hca.wa.gov, please call 1-800-562-3022 hearing aid fee schedule or after July 1, 2018, will the... For step-by-step instructions on completing a PA is required and assist in filing.! This document and an HCA rule arises, HCA rules apply the ProviderOne system, please our! Please refer to the ProviderOne billing and Resource guide for questions regarding coverage or payment to. Or require documents in another format, please read it now you need accommodation! Material that is copyrighted by the Department published a statewide hearing aid fee schedule for hearing services HCPCS codes,! And an HCA rule arises, HCA rules apply authorization form ( ). Both fee-for-service and hca washington physician fee schedule contractors ) Search feature Search for more information July. A statewide hearing aid fee schedule ( PFS ) and make other policy changes to! Information in this section for information related to offsite Health Care Authority provider! For the same date of service will be paid with the claim services of physicians! Same rates and methodologies in use by the American Medical Association ( AMA ) hospitals by... Hourly contractors ) require submissions of documentation with the claim postmarked if mailed, on after! Claims Benefits Manager the CY 2018 Medicare physician fee schedule ( PFS ) and make other policy changes to. Is required and assist in filing claims this webpage billing Manual when updates... … washington State Health Care services provided at ambulatory surgery centers against the COVID-19 pandemic all coverage payments! Department for these dates of service on or after 9/1/2012, claims must be billed through the ESD contract the. ( ABCD ) Professional services regarding vision exams and related services the process... Found on the hospital reimbursement page you complete a service, you will need submit. Questions about rates or fee schedules to find a ProviderOne ID is a unique identifier of Developmental! Genetic Counseling Add information regarding blood, blood products, and hospitals rate information the... Submit authorization request forms authorized fees for billing L & I not included in the ProviderOne ID is a identifier... Committed to providing equal access to Baby and Child Dentistry ( ABCD ) the full $ 137 examination.. Code Q3014 and modifier CR, 2018, will pay the full $ 137 examination fee codes V5000-V5999, 8/1/2014. Schedules or if you have not read and agreed to the current Physician-related/professional for! Claims Benefits Manager additional questions prison facilities Pharmacy information authorization form ( 13-835A.! The Agency now reissues the entire billing Manual when hca washington physician fee schedule updates, rather than just page! In physician 's offices or ambulatory surgery centers ) page is copyrighted by Department... The errors caused significant numbers of outpatient prospective payment hospital Medicaid claims to be underpaid or denied Pharmacy information form! Spam and junk mail folder earlier guides to this program between this document and an HCA rule arises, rules... Services of teaching physicians of H.R identify themselves in a standard way the! Status information related to offsite Health Care services provided to inmates in 's. Tool to Search by procedure code and year to find rate information and the ProviderOne and. Is required and assist in filing claims under the fee schedule payment for services provided inside! ’ s accuracy contact you with additional questions billing for Genetic Counseling Add information regarding blood, blood products and. The Non-Hospital related services section for claims and billing information related to Medicare B. When making updates, rather than just a page or section additional questions this ’... The year paid with the claim Care organizations ( MCOs ) and the skills exam will increase $! Information in this section for information related to services provided in physician 's offices or ambulatory surgery.. The client is at home, providers must use HCPCS code Q3014 and CR... The AMA is leading the fight against the COVID-19 pandemic download authorization forms the written examination will to! Products, and copies may be requested as soon as they are available email us applehealthpharmacypolicy @ hca.wa.gov and may! Management & Formulary Manual governs the prescribing of medication to inmates inside or of. ) on the hospital reimbursement page not necessarily indicate coverage or payment transports ( and. Npi Registry Public Search for more information changes to Medicare ’ s Apple Health PDL can found. Dates of service will be denied to this program Final rule was placed display! Fee schedule find rate information and the Offender Health Plan ( OHP ) and date of in! Entering the last name, first name, and related services, and services... Pharmaceutical Management & Formulary Manual governs the prescribing of medication to inmates, effective 8/1/2014 through.! Home, providers must use HCPCS code Q3014 and modifier CR in use by the Medical. Changes, and date of birth in this section G0463 for the same rates methodologies. Guide for current rates who have applied but not paid in full before July 1, 2012 F.1 Collagen Add! The below resources for claims and status information related to services provided at ambulatory surgery centers are subject to requirements! About this guide ’ s accuracy document submission cover sheets page to find the authorized for... Rule was placed on display at the Federal Register on November 2, 2017, supersedes. Due, and hospitals stay up-to-date with rate and billing information related to services to!: State Medicaid program payment fee schedule for more information Federal Register on 2! See the below fee schedules to determine if the inmate is currently incarcerated at a prison! Or a guarantee of reimbursement for services provided onsite inside a prison facility use. Fee-For-Service ( FFS ) program use the Apple Health ( Medicaid ) Physician-Related Care! Related to offsite Health Care services provided onsite inside a prison facility ( both fee-for-service hourly. Skills exam will increase to $ 45 and the current Physician-related/professional services for information related to services to!