Due to COVID-19, HCA’s lobby is closed. Learn more about your customer service options.

Provider billing guides and fee schedules

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.

This page contains billing guides, fee schedules, and additional billing materials to help you submit:

  • Prior authorization (PA) for services
  • Claims

Notice: Past billing guides may have broken links. If this occurs, please refer to the most recent guide.

Stay up-to-date with rate and billing changes, and ProviderOne system changes.

Sign up / view Provider Alerts

Prior authorization (PA)

Before you provide certain services, you will need to submit authorization request forms. 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.

For step-by-step instructions on completing a PA, visit our Prior authorization (PA) page.

Do you need a PA form? Visit our Forms and publications page to download authorization forms.

Claims

After you complete a service, you file claims through the ProviderOne portal. Use the billing guides and fee schedules to find rate information and the ProviderOne Billing and Resource Guide to walk through the claims process.

Do you need a barcode cover sheet? Visit our Document submission cover sheets page to find the barcode cover sheets required with additional documentation.

Billing guides and fee schedules

Use our billing guides and fee schedules to determine if a PA is required and assist in filing claims. 

Questions? For questions about billing guides, contact the Medical Assistance Customer Service Center (MACSC) online or at 1-800-562-3022. For questions about rates or fee schedules, email ProfessionalRates@hca.wa.gov.

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.

    Billing guides

    Discontinued 3/31/2013. Refer to the current Physician-related/professional services for information regarding blood, blood products, and related services.

    Fee schedules

    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.

    Billing guides

    Fee schedule (reimbursement/rates)

    See Inpatient Prospective Payment System (IPPS) on the Hospital reimbursement page.

    Additional information

    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.

    Fee schedules

    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.

    Billing guides

    This guide was discontinued July 1, 2020 .  For information related to withdrawal management services (previously detox), please see the agency’s Inpatient hospital guide

    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.

    Billing guides

    Physician-related/professional services fee schedules

    Enhanced pediatric fee schedules

    Medication for Opioid Use Disorder fee schedules

    Conversion factors

    Additional materials

    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.

    Billing guides

    (Effective October 1, 2015 this guide was merged into the physician-related services/health care professional services billing guide. See Physician-related/professional services.)

    Fee schedules

    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.

    Billing guides

    Apple Health (Medicaid) expedited authorization (EA) lists

    For previous versions, email us applehealthpharmacypolicy@hca.wa.gov.

    Apple Health (Medicaid) preferred drug lists (PDLs)

    Managed care plans and fee-for-service (FFS) plans

    All agency-contracted managed care organizations (MCOs) and the fee-for-service (FFS) program use the Apple Health PDL.

    The Apple Health PDL can be found on the agency’s Apple Health PDL page.

    FFS state maximum allowable cost (SMAC) list

    To request an FFS change in reimbursement

    Download the Pharmacy Information Authorization form (13-835A). Fax the request to: 866-668-1214.

    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.

    Billing guides

    Fee schedules

    Fiscal program requirements

    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.

    Billing guides

    Fee schedules

    See Physician-related/professional services for information regarding vision exams and related services.

    Vision hardware fee schedule is available through the ESD contract.

    Contact

    For fee schedule and rate questions
    Email: ProfessionalRates@hca.wa.gov

    For all other provider questions
    Medical Assistance Customer Service Center (MACSC)
    Online: web form
    Phone: 1-800-562-3022