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Provider billing guides and fee schedules
This page contains billing guides, fee schedules, and additional billing materials to help you submit:
- Prior authorization (PA) for services
- Claims
Notice: Billing guides with dates prior to October 1, 2016, will 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.
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:
- Audiology Program (see Physician-related/professional services)
- Chemical dependency (see Substance Use Disorder Program)
- Children’s mental health services (see Mental health services)
- Injectable drugs (see Professional administered drugs)
- Interpreter services (no billing guide, see our Interpreter services page)
- Occupational Therapy Program& (see Outpatient Rehabilitation Program)
- Oxygen (see Respiratory care)
- Physical Therapy Program (see Outpatient Rehabilitation Program)
- Psychology (see Mental health services)
- Speech/Audiology Program (see Outpatient Rehabilitation Program)
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
Billing guides
- April 1, 2018 to present — Acute physical medicine and rehabilitation billing guide
- January 1, 2018 to March 31, 2018 — Acute physical medicine and rehabilitation billing guide
- October 1, 2017 to December 31, 2017 — Acute physical medicine and rehabilitation billing guide
- View all acute physical medicine and rehabilitation billing guides
Billing guides
- July 1, 2018 to present — Alien Medical Program billing guide
- October 1, 2017 to June 30, 2018 — Alien Medical Program billing guide
- January 1, 2017 to September 30, 2017 — Alien Medical Program billing guide
- October 1, 2016 to December 31, 2016 — Alien Medical Program billing guide
- View all Alien Medical Program emergency assistance billing guides
Billing guides
- April 1, 2018 to present — Ambulance and ITA transportation billing guide
- January 1, 2018 to March 31, 2018 — Ambulance and ITA transportation billing guide
- October 1, 2017 to December 31, 2107 — Ambulance and ITA transportation billing guide
- View all ITA transportation billing guides
Fee schedules
- January 1, 2006 to present — Ambulance transportation (updated October 4, 2016)
Additional materials
Billing guides
- April 1, 2018 to present — ASC billing guide
- January 1, 2018 to March 31, 2018 — ASC billing guide
- October 1, 2017 to December 31, 2017 — ASC billing guide
- View all ASC billing guides
Fee schedules
- July 1, 2018- present (updated August 16,2018)
- April 1, 2018 to June 30, 2018 — ASC fee schedule (updated May 3, 2018)
- January 1, 2018 to March 31, 2018 — ASC fee schedule
- October 1, 2017 to December 31, 2017 — ASC fee schedule
- View all ASC fee schedules
Billing guides
- July 3, 2018 to present — ABA billing guide
- January 1, 2018 to June 30, 2018 — ABA billing guide
- October 2017 to December 31, 2017 — ABA billing guide
- July 1, 2017 - September 30, 2017 — ABA billing guide
- View all ABA billing guides
Fee schedules
- July 1, 2018 to present — ABA fee schedule (updated June 29, 2018)
- July 1, 2017 to June 30, 2018 — ABA fee schedule (published June 29, 2017)
- July 1, 2016 to June 30, 2017 — ABA fee schedule (published June 28, 2016)
- View all ABA fee schedules
Billing guides
Discontinued 4/1/2013. Refer to the current Physician-related/professional services for information regarding blood, blood products, and related services.
Fee schedules
- July 1, 2018 to present — Blood bank fee schedule (Published June 26, 2018)
- July 1, 2017 to June 30, 2018 — Blood bank fee schedule (Published June 29, 2017)
- October 1, 2016 to June 30, 2017 — Blood bank fee schedule (Published September 26, 2016)
- View all Blood Bank services fee schedules
Billing guides
- July 1, 2018 to present — CUP women program billing guide
- January 1, 2017 - June 30, 2018 — CUP women program billing guide
- October 1, 2016 - December 31, 2016 — CUP women program billing guide
- October 1, 2015 - September 30, 2016 — CUP women program billing guide
- View all CUP billing guides
Fee schedule (reimbursement/rates)
See Inpatient Prospective Payment System (IPPS) on the Hospital reimbursement page.
Additional information
Billing guides
- October 1, 2017 to present — Childbirth education billing guide
- January 1, 2017 to September 30, 2017 — Childbirth education billing guide
- October 1, 2016 to December 31, 2016 — Childbirth education billing guide
- View all childbirth education billing guides
Fee schedules
- January 1, 2007 to present — Childbirth education (Updated June 23, 2010)
Billing guides
- January 1, 2018 to present — Chiropractic services billing guide
- October 1, 2017 to December 31, 2017 — Chiropractic services billing guide
- July 1, 2017 to September 30, 2017 — Chiropractic services billing guide
- View all chiropractic services for children billing guides
Fee schedules
- July 1, 2018 to present — Chiropractic services for children (Published June 26, 2018)
- July 1, 2017 to June 30, 2018 — Chiropractic services for children(Published June 29, 2017)
- July 1, 2016 to June 30, 2017 — Chiropractic services for children (Published June 28, 2016)
- View all chiropractic services for children fee schedules
Billing guides
- July 1, 2018 to present — CRT products and services billing guide
- January 1, 2018 to June 30, 2018 — CRT products and services billing guide
- October 1, 2017 to December 31, 2017 — CRT products and services billing guide
- July 1, 2017 to September 30, 2017 — CRT products and services billing guide
- View all CRT billing guides
Fee schedules
- July 1, 2018 to present — CRT (Published July 2, 2018)
- April 1, 2018 to June 30, 2018 — CRT (Updated April 12, 2018)
- January 1, 2018 to March 31, 2018 — CRT products and services billing guide (Updated December 28, 2017)
- View all CRT fee schedules
Additional materials
Billing guides
Access to Baby and Child Dentistry (ABCD)
See Access to Baby and Child Dentistry (ABCD).
Dental-related services
- July 1, 2018 to present — Dental-related services program billing guide
- April 1, 2018 to June 30, 2018 — Dental-related services program billing guide
- January 1, 2018 to March 31, 2018 — Dental-related services program billing guide
- November 3, 2017 to December 31, 2017 — Dental-related services program billing guide
- View all dental services billing guides
Fee schedules
- July 1, 2018 to present — Dental program fee schedule (Updated July 2, 2018)
- April 1, 2018 to June 30, 2018 — Dental program fee schedule(Updated May 10, 2018)
- January 1, 2018 to March 31, 2018 — Dental program fee schedule (Updated February 26, 2018)
- View all dental services fee schedules
Billing guides
- January 1, 2018 to present — Diabetes education program billing guide
- October 1, 2017 to December 31, 2017 — Diabetes education program billing guide
- July 1, 2017 to September 30, 2017 — Diabetes education program billing guide
- View all Diabetes Education Program billing guides
Fee schedules
- July 1, 2018 to present — Diabetes education (Published June 26, 2018)
- July 1, 2017 to June 30, 2018 — Diabetes education (Published June 29, 2017)
- July 1, 2016 to June 30, 2017 — Diabetes education (Published June 28, 2016)
- View all Diabetes Education Program fee schedules
Billing guides
- July 1, 2018 to present — DME and non-CRT wheelchairs billing guide
- January 1, 2018 to June 30, 2018 — DME and non-CRT wheelchairs billing guide
- October 1, 2017 to December 31, 2017 — DME and non-CRT wheelchairs billing guide
- July 1, 2017 to September 30, 2017 — DME and non-CRT wheelchairs billing guide
- View all DME billing guides
Fee schedules
Other DME
- July 1, 2018 to present — Other DME fee schedule (Published July 2, 2018)
- April 1, 2018 to June 30, 2018 — Other DME fee schedule (Published April 6, 2018)
- January 1, 2018 to March 31, 2018 — Other DME fee schedule (Published December 29, 2017)
- View all Other DME fee schedules
Standard wheelchairs and accessories
- July 1, 2018 to present — Wheelchairs and accessories (Published July 2, 2018)
- January 1, 2018 to June 30, 2018 — Wheelchairs and accessories (Published January 3, 2018)
- April 1, 2016 to December 31, 2017 — Wheelchairs and accessories (Published March 11, 2016)
- View all standard wheelchairs fee schedules
Additional materials
Billing guides
- April 1, 2018 to present — EPSDT program billing guide
- January 1, 2018 to March 31, 2018 — EPSDT program billing guide
- October 1, 2017 to December 31, 2017 — EPSDT program billing guide
- View all EPSDT billing guides
Fee schedules
- July 1, 2018 to present — EPSDT fee schedule (Published June 26, 2018)
- January 1, 2018 to June 30, 2018 — EPSDT fee schedule (Updated January 3, 2018)
- July 1, 2017 to December 31, 2017 — EPSDT fee schedule (Published June 29, 2017)
- View all EPSDT fee schedules
Billing guides
- July 1, 2018 to present — Enteral nutrition billing guide
- January 1, 2018 to June 30, 2018 — Enteral nutrition billing guide
- October 1, 2017 to December 31, 2017 — Enteral nutrition billing guide
- July 1, 2017 to September 30, 2017 — Enteral nutrition billing guide
- View all enteral nutrition billing guides
Fee schedules
- July 1, 2015 to present — Enteral nutrition fee schedule (Published June 23, 2015)
- January 1, 2015 to June 30, 2015 — Enteral nutrition fee schedule (Updated March 16, 2015)
- View all enteral nutrition fee schedules
Billing guides
- July 1, 2018 to present — Family planning billing guide
- January 1, 2018 to June 30, 2018 — Family planning billing guide
- October 1, 2017 to December 31, 2017 — Family planning billing guide
- July 1, 2017 to September 30, 2017 — Family planning billing guide
- View all family planning billing guides
Fee schedules
- July 1, 2018 to present — Family planning (Updated July 10, 2018)
- April 1, 2018 to June 30, 2018 — Family planning (Updated April 20, 2018)
- January 1, 2018 to March 31, 2018 — Family planning billing guide (Updated January 23, 2018)
- View all family planning fee schedules
Additional Materials
- Sterilization Supplemental Billing Guide
- Physician-Related Services/Health Care Professional Services Billing Guide
- Physician administered drugs fee schedule
- Prescription Drug Program Billing Guide
Take Charge
- Take Charge program (family planning non-Medicaid)
- Take Charge provider directory
- Take Charge Client Application (form 13-781)
- Take Charge SSN referral (form 13-823)
Billing guides
- July 1, 2018 to present — FQHC billing guide
- April 1, 2018 to June 30, 2018 — FQHC billing guide
- January 1, 2018 to March 31, 2018 — FQHC billing guide
- October 1, 2017 to December 31, 2017 — FQHC billing guide
- View all FQHC billing guides
Encounter rates
- July 1, 2018 to present — FQHC rates (Updated July 24, 2018)
- April 1, 2018 to June 30, 2018 — FQHC rates (Updated June 20, 2018)
- January 1, 2018 to March 31, 2018 — FQHC rates (Updated April 23, 2018)
- View all encounter rates
Enhancement rates
- July 1, 2018 to present — FQHC enhancement rates (Published June 29, 2018)
- April 1, 2018 to June 30, 2018 — FQHC enhancement rates (Updated May 2, 2018)
- January 1, 2018 to March 31, 2018 — FQHC enhancement rates (Uploaded January 3, 2018)
- View all enhancement rates
Billing guides
- January 1, 2018 to present — Habilitative services program billing guide
- October 1, 2017 to December 31, 2017 — Habilitative services program billing guide
- July 1, 2017 to September 30, 2017 — Habilitative services program billing guide
- View all habilitative services billing guides
Fee schedules
- July 1, 2018 to present — Habilitative services (Published June 26, 2018)
- January 1, 2018 to June 30, 2018 — Habilitative services (Updated January 19, 2018)
- July 1, 2017 to December 31, 2017 — Habilitative services (Published June 29, 2017)
- View all habilitative services fee schedules
For Apple Health clients age 20 and younger and DDA clients age 21 and older.
Billing guides
- January 1, 2018 to present — Hearing hardware billing guide
- October 1, 2017 to December 31, 2017 — Hearing hardware billing guide
- July 1, 2017 to September 30, 2017 — Hearing hardware billing guide
- View all hearing hardware billing guides
Fee schedules
- January 1, 2018 to present — Hearing hardware (Published December 27, 2017)
- July 1, 2015 to December 31, 2017 — Hearing hardware (Published June 23, 2015)
- January 1, 2015 to June 30, 2015 — Hearing hardware (Published December 22, 2014)
- View all hearing hardware fee schedules
Additional materials
Billing guides
- July 1, 2018 to present — HIV/AIDS case management billing guide
- January 1, 2018 to June 30, 2018 — HIV/AIDS case management billing guide
- October 1, 2017 to December 31, 2017 — HIV/AIDS case management billing guide
- July 1, 2017 to September 30, 2017 — HIV/AIDS case management billing guide
- View all HIV/AIDS program billing guides
Fee schedules
- July 1, 2018 to present — HIV/AIDS case management (Published June 26, 2018)
- July 1, 2016 to June 30, 2018 — HIV/AIDS case management (Published June 28, 2016)
- April 1, 2016 to June 30, 2016 — HIV/AIDS case management (Published March 25, 2016)
- View all HIV/AIDS program fee schedule
Billing guides
- January 1, 2018 to present — Home health (acute care services) billing guide
- October 1, 2017 to December 31, 2017 — Home health (acute care services) billing guide
- July 1, 2017 to September 30, 2017 — Home health (acute care services) billing guide
- View all home health services billing guides
Fee schedules
- July 1, 2018 to present — Home health (Published June 29, 2018)
- April 1, 2018 to June 30, 2018 — Home health (Published April 2, 2018)
- January 1, 2018 to March 31, 2018 — Home health (Published February 15, 2018)
- View all home health services fee schedules
Billing guides
- January 1, 2018 to present — Home infusion therapy billing guide
- October 1, 2017 to December 31, 2017 — Home infusion therapy billing guide
- July 1, 2017 to September 30, 2017 — Home infusion therapy billing guide
- View all home infusion therapy and nutrition billing guides
Fee schedules
- January 1, 2018 to present — Home Infusion Therapy/Parenteral Nutrition Program (Published December 29, 2017)
- July 1, 2017 to December 31, 2017 — Home Infusion Therapy/Parenteral Nutrition Program (Updated July 31, 2017)
- January 1, 2017 to June 30, 2017 — Home Infusion Therapy/Parenteral Nutrition Program (Published July, 31, 2017
- View all home infusion therapy and nutrition fee schedules
Additional materials
Billing guides
- May 1, 2018 to present — Hospice services billing guide
- October 1, 2017 to April 30, 2018 — Hospice services billing guide
- July 1, 2017 to September 30, 2017 — Hospice services billing guide
- View all hospice billing guides
Fee schedules
- October 1, 2017 to present — Hospice rates (Published October 2, 2017)
- October 1, 2016 to September 30, 2017 — Hospice rates (Published September 21, 2016)
- January 1, 2016 to September 30, 2016 — Hospice rates (Published August 18, 2016)
- View all hospice fee schedules
Billing guides
- January 1, 2018 to present — Hospital-based inpatient detoxification billing guide
- October 1, 2017 to December 31, 2017 — Hospital-based inpatient detoxification billing guide
- July 1, 2017 to September 30, 2017 — Hospital-based inpatient detoxification billing guide
- View all hospital-based inpatient detoxification billing guides
Billing guides
- July 1, 2018 to present — Inpatient hospital services billing guide
- April 1, 2018 to June 30, 2018 — Inpatient hospital services billing guide
- January 1, 2018 to March 31, 2018 — Inpatient hospital services billing guide
- October 1, 2017 to December 31, 2017 — Inpatient hospital services billing guide
- View all inpatient hospital billing guides
Fee schedule (reimbursement/rates)
See Inpatient Prospective Payment System (IPPS) on the Hospital reimbursement page.
Additional information
Billing guides
- July 1, 2018 to present — Kidney center services billing guide
- April 1, 2018 to June 30, 2018 — Kidney center services billing guide
- January 1, 2018 to March 31, 2018 — Kidney center services billing guide
- October 1, 2017 to December 31, 2017 — Kidney center services billing guide
- View all kidney center services billing guides
Fee schedules
- July 1, 2018 to present — Kidney centers fee schedule (Updated June 27, 2018)
- April 1, 2018 to June 30, 2018 — Kidney centers fee schedule (Published March 19, 2018)
- January 1, 2018 to March 31, 2018 — Kidney centers fee schedule (Published December 19, 2017)
- View all kidney center services fee schedules
Billing guides
- July 1, 2018 to present — MSS/ICM billing guide
- April 1, 2018 - June 30, 2018 — MSS/ICM billing guide
- January 1, 2018 to March 31, 2018 — MSS/ICM billing guide
- December 18, 2017 to December 31, 2017 — MSS/ICM billing guide
- View all MSS/ICM billing guides
Fee schedules
- October 1, 2015 to present — MSS/ICM case management (Published October 7, 2015)
- July 1, 2015 to September 30, 2015 — MSS/ICM case management (Published June 15, 2015)
- View all MSS/ICM fee schedules
Billing guides
- January 1, 2018 to present — Medical nutrition therapy billing guide
- October 1, 2017 - December 31, 2017 — Medical nutrition therapy billing guide
- July 1, 2017 - September 30, 2017 — Medical nutrition therapy billing guide
- View all medical nutrition therapy billing guides
Fee schedules
- July 1, 2018 to present — Medical nutrition therapy (Published June 26, 2018)
- July 1, 2017 to June 30, 2018 — Medical nutrition therapy (Published June 29, 2017)
- July 1, 2016 to June 30, 2017 — Medical nutrition therapy (Published June 28, 2016)
- View all medical nutrition therapy fee schedules
Additional materials
Billing guides
- July 1, 2018 to present — Mental health services billing guide
- April 1, 2018 to June 30, 2018 — Mental health services billing guide
- January 1, 2018 to March 31, 2018 — Mental health services billing guide
- October 1, 2017 to December 31, 2017 — Mental health services billing guide
- View all mental health services billing guides
Fee schedules
Mental health services
- July 1, 2018 to present — Mental health and psychology services (Published June 26, 2018)
- January 1, 2018 to June 30, 2018 — Mental health and psychology services (Updated December 29, 2017)
- July 1, 2017 to December 31, 2017 — Mental health and psychology services (Published June 29, 2017)
- View all mental health services fee schedules
Specialized mental health services
- July 1, 2018 to present — Specialized mental health (Published June 29, 2018)
- January 1, 2018 to June 30, 2018 — Specialized mental health (Published December 27, 2017)
- July 1, 2017 to December 31, 2017 — Specialized mental health (Published June 29, 2017)
Billing guides
- July 1, 2018 to present — Neurodevelopmental centers billing guide
- January 1, 2017 to June 30, 2018 — Neurodevelopmental centers billing guide
- October 1, 2016 to December 31, 2016 — Neurodevelopmental centers billing guide
- October 1, 2015 to September 30, 2016 — Neurodevelopmental centers billing guide
- View all neurodevelopmental centers billing guides
Fee schedules
- July 1, 2018 to present — Neurodevelopmental centers fee schedule (Published June 29, 2018)
- January 1, 2018 to June 30, 2018 — Neurodevelopmental centers fee schedule (Updated January 19, 2018)
- July 1, 2017 to December 31, 2017 — Neurodevelopmental centers fee schedule (Published June 29, 2017)
- View all neurodevelopmental centers fee schedules
Billing guides
- July 1, 2018 - present
- January 1, 2018 - June 30, 2018
- October 1, 2017 - December 31, 2017
- July 1, 2017 - September 30, 2017
- View all nondurable medical supplies and equipment billing guides
Fee schedules
- January 1, 2018 - present (Published December 29, 2017)
- January 1, 2017 - December 31, 2017 (Published December 28, 2016)
- April 1, 2016 - December 31, 2016 (Updated July 8, 2016)
- View all nondurable medical supplies and equipment fee schedules
Billing guides
- July 1, 2018 - present
- January 1, 2018 - June 30, 2018
- October 1, 2017 - December 31, 2017
- July 1, 2017 - September 30, 2017
- View all nursing facilities billing guides
Additional information
Billing guides
- July 1, 2018 - present
- April 26, 2018 - June 30, 2018
- April 1, 2018 - April 25, 2018
- January 1, 2018 - March 31, 2018
- View all outpatient billing guides
Fee schedules
- July 1, 2018 to present — OPPS fee schedule (updated August 2, 2018)
- April 1, 2018 to June 30, 2018 — OPPS fee schedule (updated April 24, 2018)
- January 1, 2018 to March 31, 2018 — OPPS fee schedule (updated February 12, 2018)
- View all outpatient fee schedules
Additional information
Billing guides
- January 1, 2018 - present
- October 1, 2017 - December 31, 2017
- August 14, 2017 - September 30, 2017
- View all Outpatient Rehabilitation Program billing guides
Fee schedules
- July 1, 2018 - present (Published June 29, 2018)
- January 1, 2018 - June 30, 2018 (Updated January 19, 2018)
- July 1, 2017 - December 31, 2017 (Published June 29, 2017)
- View all Outpatient Rehabilitation Program fee schedules
Additional materials
- Social services supplement (Updated January 1, 2017)
- Social services supplement (Updated August 7, 2015)
- Social services blanket codes (April 28, 2017-present)
- Social services blanket codes(January 1, 2017 - April 27, 2017)
- Social services blanket codes (August 7, 2015 - December 31, 2016)
Fee schedules
- July 1, 2018 - Present (updated July 30, 2018)
- January 1, 2018 - June 30, 2018 (updated March 14, 2018)
- October 1, 2017 - December 31, 2017 (published March 14, 2018)
- View all pharmacy special services fee schedules
Billing guides
- July 1, 2018 - present
- May 1, 2018 - June 30, 2018
- April 15, 2018 - April 30, 2018
- March 1, 2018 - April 14, 2018
- View all physician-related/professional services billing guides
Fee schedules
- July 1, 2018 - present (updated July 30, 2018)
- April 1, 2018 - June 30, 2018 (updated April 16, 2018)
- January 1, 2018 - March 31, 2018 (updated March 9, 2018)
- View all physician-related/professional services fee schedules
Audiology services fee schedules (Prior to January 1, 2017)
- July 1, 2016 - December 31, 2016 (Updated July 21, 2016)
- April 1, 2016 - June 30, 2016 (Published April 27, 2016)
- View all Audiology Program fee schedules
Conversion factors
- July 1, 2018 - present (Published June 29, 2018)
- July 1, 2017 - June 30, 2018 (Published June 29, 2017)
- July 1, 2016 - June 30, 2017
- View all conversion factors
Additional materials
Billing guides
- July 1, 2018 - present
- April 1, 2018 - June 30, 2018
- January 1, 2018 - March 31, 2018
- October 1, 2017 - December 31, 2017
- View all planned home births billing guides
Fee schedules
- July 1, 2018 - present (Published June 29, 2018)
- March 1, 2018 - June 30, 2018 (Published February 15, 2018)
- July 1, 2017 - February 28, 2018 (Updated July 18, 2017)
- View all planned home births fee schedules
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.)
Previous prenatal diagnosis genetic counseling billing guides
- April 1, 2014 - September 30, 2015
- March 8, 2013 - March 31, 2014
- July 1, 2011 - March 7, 2013
- May 9, 2010 - June 30, 2011
- January 1, 2007 - May 8, 2010
Fee schedules
- July 1, 2017 - present (Published June 29, 2017)
- July 1, 2016 - June 30, 2017 (Published June 28, 2016)
- July 1, 2015 - June 30, 2016 (Posted March 25, 2016)
- View all prenatal diagnosis genetic counseling fee schedules
Billing guides
- July 1, 2018 - present
- April 1, 2018 - June 30, 2018
- March 1, 2018 - March 31, 2018
- January 19, 2018 - February 28, 2018
- View all billing guides
Apple Health (Medicaid) expedited authorization (EA) lists
- July 1, 2018 - present
- February 1, 2018 - June 30, 2018
- January 1, 2018 - January 31, 2018
- November 1, 2017 - December 31, 2017
- View all EA lists
For previous versions, email us applehealthpharmacypolicy@hca.wa.gov.
Apple Health (Medicaid) preferred drug lists (PDLs)
Managed care plans
Fee-for-service (FFS)
- July 1, 2018 - present
- January 10, 2018 - June 30, 2018
- January 1, 2018 - January 9, 2018
- November 1, 2017 - December 31, 2017
- View all FFS PDLs
For previous versions, email us applehealthpharmacypolicy@hca.wa.gov.
FFS state maximum allowable cost (SMAC) list
To request an FFS change in reimbursement
Download thePharmacy Information Authorization form (13-835A). Fax the request to: 866-668-1214.
For children
Billing guides
- July 1, 2018 - present
- October 1, 2017 - June 30, 2018
- July 1, 2017 - September 30, 2017
- January 1, 2017 - June 30, 2017
- View all private duty nursing for children billing guides
Fee schedules
- July 1, 2016 - present (Published June 22, 2016)
- July 1, 2007 - June 30, 2016 (Updated June 23, 2010)
Additional materials
For adults
- Social services supplement for adults (Published January 1, 2017)
- Social services supplement for adults (Published January 15, 2015)
Fee schedules
- July 1, 2018 - present (Published July 2, 2018)
- April 1, 2018 - June 30, 2018 (Updated May 15, 2018)
- January 1, 2018 - March 31, 2018 (Updated March 6, 2018)
- View all professional administered drugs fee schedules
Fee schedules (prior to July 1, 2016)
- April 1, 2016 - June 30, 2016 (Published March 25, 2016)
- January 1, 2016 - March 31, 2016 (Updated February 12, 2016)
- View all injectables fee schedules
Billing guides
- July 1, 2018 - present
- April 1, 2018 - June 30, 2018
- January 1, 2018 - March 31, 2018
- October 1, 2017 - December 31, 2017
- View all prosthetic and orthotics billing guides
Fee schedules
- July 1, 2018 - present (Published June 29, 2018)
- April 1, 2018 - June 30, 2018(Published April 2, 2018)
- October 1, 2017 - March 31, 2018 (Published September 26, 2017)
- View all prosthetic and orthotics fee schedules
Additional materials
- Social services supplement (Updated August 7, 2015)
- Social services blanket codes (January 1, 2017 - present)
- Social services billing codes (Updated August 7, 2015)
Billing guides
- July 1, 2018 - present
- April 1, 2018 - June 30, 2018
- January 1, 2018 - March 31, 2018
- October 1, 2017 - December 31, 2017
- View all respiratory care billing guides
Fee schedules
- July 1, 2018 - present (Published June 29, 2018)
- January 1, 2018 - June 30, 2018 (Updated January 4, 2018)
- January 1, 2017 - December 31, 2017 (Updated March 20, 2017)
- View all respiratory care fee schedules
Additional materials
- Social services supplement (Updated August 7, 2015)
- Social services blanket codes (January 1, 2017 - present)
- Social services billing codes (Updated August 7, 2015)
Billing guides
- July 1, 2018 - present
- April 1, 2018 - June 30, 2018
- January 1, 2018 - March 31, 2018
- October 1, 2017 - December 31, 2017
- View all RHC billing guides
Encounter rates
- July 1, 2018 - present (updated August 15, 2018)
- April 1, 2018 - June 30, 2018 (updated June 19, 2018)
- January 1, 2018 - March 31, 2018 (updated March 21, 2018)
- View all encounter rates
Enhancement rates
- July 1, 2018 - present (Published June 29, 2018)
- January 1, 2018 - June 30, 2018 (Uploaded January 3, 2018)
- October 1, 2017 - December 31, 2017
- View all enhancement rates
Billing guides
- January 1, 2018 - present
- January 1, 2017 - December 31, 2017
- October 1, 2016 - December 31, 2016
- View all SBHS billing guides
Fee schedules
- July 1, 2018 - present (Updated July 11, 2018)
- January 1, 2018 - June 30, 2018 (Published December 27, 2017)
- July 1, 2017 - December 31, 2017 (Published June 29, 2017)
- View all SBHS fee schedules
Billing guides
- January 1, 2018 - present
- October 1, 2017 - December 31, 2017
- July 1, 2017 - September 30, 2017
- View all sterilization billing guides
Fee schedules
See Physician-related/professional services
Additional materials
Billing guides
- August 1, 2018 - present
(Fee-for-service benefits provided outside of the BHO process) - July 1, 2018 - July 31, 2018
(Fee-for-service benefits provided outside of the BHO process) - April 1, 2018 - June 30, 2018
(Fee-for-service benefits provided outside of the BHO process) - January 1, 2018 - March 31, 2108
(Fee-for-service benefits provided outside of the BHO process) - October 1, 207 - December 31, 2017
(Fee-for-service benefits provided outside of the BHO process) - View all SUD (FFS outside BHO process) billing guides
- View all SUD (outpatient) billing guides
Fee schedules
-
August 1, 2018 to present — Substance use disorder fee schedule (published August 1, 2018)
- July 1, 2018 to July 31, 2018 — Substance use disorder fee schedule (published June 29, 2018)
- July 1, 2017 to June 30, 2018 — Substance use disorder fee schedule (published June 29, 2017)
- View all substance use disorder fee schedules
Billing guides
- April 1, 2018 - present
- January 1, 2018 - March 31, 2018
- October 1, 2017 - December 31, 2017
- View all Tribal Health Program billing guides
Fee schedules
- July 1, 2018 - present (Updated July 18, 2018)
- January 1, 2018 - June 30, 2018 (Published December 31, 2017)
Billing guides
- July 1, 2018 - present
- January 1, 2018 - June 30, 2018
- October 1, 2017 - December 31, 2017
- July 30, 2017 - September 30, 2017
- View all vision hardware 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
