Provider billing guides and fee schedules

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 and psychology (see Mental health services)
• Injectable drugs (see Professional administered drugs)
• Interpreter services (no billing guide, see our Interpreter services page)
• Occupational therapy, physical therapy, and speech/audiology (see Outpatient Rehabilitation Program)
• Oxygen (see Respiratory care)

Billing guides

• 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
• View all ABCD billing guides

Fee schedules

See Dental Program.

Billing guides 

• 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

Billing guides

• April 1, 2021 to present — Alien Medical Program billing guide
• October 1, 2020 to March 31, 2021 — Alien Medical Program billing guide
• October 1, 2019 to September 30, 2020 — Alien Medical Program billing guide
• View all Alien Medical Program emergency assistance billing guides

Billing guides

   Ambulance transportation 

• 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

   Ground Emergency Medical Transportation (GEMT)

• 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

Fee schedules

• February 29, 2020 to present — Ambulance transportation (updated April 17, 2020)
• July 1, 2019 to February 28, 2020 — Ambulance transportation (updated May 29, 2019)
• December 1, 2016 to June 30, 2019 — Ambulance transportation (updated December 09, 2016)
• January 1, 2006 to November 30, 2016 —  Ambulance transportation (updated February 10, 2016)

Additional materials

• Treat and refer attestation
• Transportation matrix

Billing guides

• 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
• View all ASC billing guides

Fee schedules

• March 1, 2021 to present -- ASC fee schedule (updated March 31, 2021)
• July 1, 2020 to February 28, 2021 — ASC fee schedule (updated December 3, 2020)
• January 1, 2020 to June 30, 2020 — ASC fee schedule (updated September 29, 2020)
• July 1, 2018 to December 31, 2019 — ASC fee schedule (updated August 16,2018)
• View all ASC fee schedules

Billing guides

• March 1, 2021 to present - ABA billing guide
• February 1, 2021 to February 28, 2021 - ABA billing guide
• December 1, 2020 to January 31, 2021 - ABA billing guide
• View all ABA billing guides

Fee schedules

• July 1, 2020 to present — ABA fee schedule (published June 29, 2020)
• July 1, 2019 to June 30, 2020 — ABA fee schedule (published June 24, 2019)
• January 1, 2019 to June 30, 2019 — ABA fee schedule (updated January 22, 2019)
• View all ABA fee schedules

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

• July 1, 2020 to present — Blood bank fee schedule (published June 30, 2020)
• July 1, 2019 to June 30, 2020 — Blood bank fee schedule (published July 1, 2019)
• January 1, 2019 to June 30, 2019 — Blood bank fee schedule (published December 28, 2018)
• View all Blood Bank services fee schedules

Billing guides

• 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
• View all CUP billing guides

Fee schedule (reimbursement/rates)

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

Additional information

• HCA revenue code grids

Billing guides

• 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

Fee schedules

• January 1, 2007 to present — Childbirth education (updated June 23, 2010)

Billing guides

• 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

Fee schedules

• July 1, 2020 to present — Chiropractic services for children (updated March 15, 2021)
• July 1, 2019 to June 30, 2020 — Chiropractic services for children (published June 24, 2019)
• July 1, 2018 to June 30, 2019 — Chiropractic services for children (published June 26, 2018)
• View all chiropractic services for children fee schedules

Billing guides

• 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
• View all CRT billing guides

Fee schedules

• July 1, 2020 to present — CRT fee schedule (published June 29, 2020)
• January 1, 2020 to June 30, 2020 — CRT fee schedule (published December 31, 2019)
• January 1, 2019 to December 31, 2019 — CRT fee schedule (updated December 3, 2019)
• View all CRT fee schedules

Social Services

• Social services supplement (updated October 1, 2020)
• November 17, 2020 to present - Social services blanket codes
• May 22, 2020 to November 16, 2020 — Social services blanket codes
• View all social services blanket codes

Fee schedules

• April 1, 2021 to present — COVID-19 fee schedule (updated April 22, 2021)
• February 15, 2021 to March 31, 2021 — COVID-19 fee schedule (updated March 1, 2021)
• January 1, 2021 to February 14, 2021 — COVID-19 fee schedule (updated February 23, 2021)
• View all COVID-19 fee schedules

Billing guides

Access to Baby and Child Dentistry (ABCD)

See Access to Baby and Child Dentistry (ABCD).

Dental-related services

• April  1, 2021 to present — Dental-related services program billing guide
• March 1, 2021 to March 31, 2021 — Dental-related services program billing guide
• January 8, 2021 to February 28, 2021 — Dental-related services program billing guide
• View all dental services billing guides

Oral Health Connections (OHC) pilot project

• 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

Fee schedules

• April 1, 2021 to present — Dental program fee schedule (published March 31, 2021)
• January 8, 2021 to March 31, 2021 — Dental program fee schedule (published January 11, 2021)
• October 1, 2020 to January 7, 2021 — Dental program fee schedule (published September 29, 2020)
• View all dental services fee schedules

Billing guides

• April 1, 2021 to present — Diabetes education program billing guide
• October 1, 2020 to March 31, 2021 — Diabetes education program billing guide
• January 1, 2020 to September 30, 2020 — Diabetes education program billing guide
• View all Diabetes Education Program billing guides

Fee schedules

• July 1, 2020 to present — Diabetes education (published June 29, 2020)
• July 1, 2019 to June 30, 2020 — Diabetes education (published June 24, 2019)
• July 1, 2018 to June 30, 2019 — Diabetes education (published June 26, 2018)
• View all Diabetes Education Program fee schedules

Billing guides

• April 1, 2019 to present — Refer to the Medical Equipment and Supplies billing guide for information regarding durable medical equipment.
• 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
• View all DME billing guides

Fee schedules

Other DME

• January 1, 2019 to March 31, 2019 — Other DME fee schedule (updated December 3, 2019)
• July 1, 2018 to December 31, 2018 — Other DME fee schedule (published July 2, 2018)
• April 1, 2018 to June 30, 2018 — Other DME fee schedule (published April 6, 2018)
• View all Other DME fee schedules

Standard wheelchairs and accessories

• January 1, 2019 to March 31, 2019 — Wheelchairs and accessories fee schedule (updated December 3, 2019)
• July 1, 2018 to December 31, 2018 — Wheelchairs and accessories fee schedule (updated November 6, 2018)
• January 1, 2018 to June 30, 2018 — Wheelchairs and accessories fee schedule (published January 3, 2018)
• View all standard wheelchairs fee schedules

Additional materials

• View all DME social services blanket codes

Billing guides

• April 1, 2021 to present — EPSDT program billing guide
• January 1, 2021 to March 31, 2021 — EPSDT program billing guide
• October 1, 2020 to December 31, 2020 — EPSDT program billing guide
• View all EPSDT billing guides

Fee schedules

• July 1, 2020 to present — EPSDT fee schedule (published June 29, 2020)
• January 1, 2020 to June 30, 2020 — EPSDT fee schedule (published December 31, 2019)
• July 1, 2019 to December 31, 2019 — EPSDT fee schedule (published June 24, 2019)
• View all EPSDT fee schedules

Periodicity schedules

• ​ EPSDT periodicity schedule (Updated April 1, 2021)

Billing guides

• April 1, 2021 to present — Enteral nutrition billing guide
• October 1, 2020 to  March 31, 2021 — Enteral nutrition billing guide
• April 1, 2020 to September 30, 2020 — Enteral nutrition billing guide
• View all enteral nutrition billing guides

Fee schedules

• July 1, 2020 to present — Enteral nutrition fee schedule (updated July 21, 2020)
• January 1, 2019 to June 30, 2020 — Enteral nutrition fee schedule (published November 6, 2019)
• October 1, 2018 to December 31, 2018 — Enteral nutrition fee schedule (published October 2, 2018)
• View all enteral nutrition fee schedules

Billing guides

• April 1, 2021 to present — Family planning billing guide
• January 1, 2021 to March 31, 2021 — Family planning billing guide
• October 1, 2020 to December 31, 2020 — Family planning billing guide
• View all family planning billing guides

Fee schedules

• April 1, 2021 to present — Family planning fee schedule (published March 30, 2021)
• January 1, 2021 to March 31, 2021 — Family planning fee schedule (updated March 8, 2021)
• July 1, 2020 to December 31, 2020 — Family planning fee schedule (published June 30, 2020)
• 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

Family planning

• Family planning only program telemedicine services offered during the COVID-19 outbreak (March 2020)
• Family planning program (family planning non-Medicaid)
• Family planning client application (form 13-781)

Billing guides

• April 1, 2021 to present — FQHC billing guide 
• January 1, 2021 to March 31, 2021 — FQHC billing guide 
• October 1, 2020 to December 31, 2020 — FQHC billing guide 
• View all FQHC billing guides

Encounter rates

• April 1, 2021 to present —  FQHC encounter rates (updated March 30, 2021)
• January 1, 2021 to March 31, 2021 — FQHC encounter rates (updated March 30, 2021)
• October 1, 2020 to December 31, 2020 — FQHC encounter rates (updated January 19, 2021)
• View all encounter rates

Enhancement rates

• April 1, 2021 to present — FQHC enhancement rates (updated May 6, 2021)
• January 1, 2021 to March 31, 2021 — FQHC enhancement rates (updated May 6, 2021)
• October 1, 2020 to December 31, 2020 — FQHC enhancement rates (updated May 6, 2021)
• View all enhancement rates

Billing guides

• 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

Fee schedules

• January 1, 2021 to present — Habilitative services (updated January 4, 2021)
• July 1, 2020 to December 31, 2020 — Habilitative services (published June 29, 2020)
• April 1, 2020 to June 30, 2020 — Habilitative services (published March 26, 2020)
• View all habilitative services fee schedules

For Apple Health clients and clients of the Developmental Disabilities Administration.

Billing guides

• 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
• View all hearing hardware billing guides

Fee schedules

• October 1, 2020 to present — Hearing hardware fee schedule (published September 28, 2020)
• July 1, 2020 to September 30, 2020 — Hearing hardware fee schedule (updated November 3, 2020)
• January 1, 2019 to June 30, 2020 — Hearing hardware fee schedule (updated February 25, 2019)
• View all hearing hardware fee schedules

Social Services

• Social services supplement (updated October 1, 2020)
• November 17, 2020 to present - Social services blanket codes 
• May 22, 2020 to November 16, 2020 — Social services blanket codes
• View all social services blanket codes

Billing guides

• April 1, 2021 to present — HIV/AIDS case management billing guide
• October 1, 2020 to March 31, 2021 — HIV/AIDS case management billing guide
• January 1, 2020 to September 30, 2020 — 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)
• View all HIV/AIDS program fee schedule

Billing guides

• April 1, 2021 to present — Home health (acute care services) billing guide
• October 1, 2020 to March 31, 2021 — Home health (acute care services) billing guide
• July 1, 2020 to September 30, 2020 — Home health (acute care services) billing guide
• View all home health services billing guides

Fee schedules

• January 1, 2021 to present — Home health fee schedule (published February 1, 2021)
• July 1, 2020 to December 31, 2020 — Home health fee schedule (published June 30, 2020)
• July 1, 2019 to June 30, 2020 — Home health fee schedule (published July 1, 2019)
• View all home health services fee schedules

Billing guides

• 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

Fee schedules

• January 1, 2021 to present — Home infusion therapy/parenteral nutrition fee schedule (published December 22, 2020)
• October 1, 2020 to December 31, 2020 — Home infusion therapy/parenteral nutrition fee schedule (published November 10, 2020)
• July 1, 2020 to September 30, 2020 — Home infusion therapy/parenteral nutrition fee schedule (published July 1, 2020)
• View all home infusion therapy/parenteral nutrition fee schedules

Social Services

• Social services supplement (updated October 1, 2020)
• November 17, 2020 to present - Social services blanket codes
• May 22, 2020 to November 16, 2020 — Social services blanket codes
• View all social services blanket codes

Billing guides

• 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
• View all hospice billing guides

Fee schedules

• October 1, 2020 to present — Hospice fee schedule (published September 21, 2020)
• October 1, 2019 to September 30, 2020 — Hospice fee schedule (published September 30, 2019)
• October 1, 2018 to September 30, 2019 — Hospice fee schedule (published September 24, 2018)
• View all hospice fee schedules

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

• 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

Billing guides

• January 1, 2021 to present - Inpatient hospital services billing guide
• October 1, 2020 to December  31, 2020 - Inpatient hospital services billing guide
• August 10, 2020 to September 30, 2020 - 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

• HCA revenue code grids
• Guidance for billing MCOs for services provided to newborns
• RAC Eligibility Codes for Healthy Options - Blind/Disabled (HOBD) Clients

Billing guides

• 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

Fee schedules

• April 1, 2021 to present — Kidney centers fee schedule (published March 29, 2021)
• January 1, 2021 to March 31, 2021 — Kidney centers fee schedule (published December 23, 2020)
• October 1, 2020 to December 31, 2020 — Kidney centers fee schedule (updated October 7, 2020)
• View all kidney center services fee schedules

Billing guides

• 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

Billing guides

• 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
• View all MSS/ICM billing guides

Fee schedules

• July 1, 2020 to present — MSS/ICM fee schedule (published July 1, 2020)
• January 1, 2020 to June 30, 2020 — MSS/ICM fee schedule (published January 9, 2020)
• October 1, 2015 to December 31, 2019 — MSS/ICM fee schedule (published October 7, 2015)
• View all MSS/ICM fee schedules

Billing guides

• 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

Fee schedules

• January 1, 2021 to present — Medical Equipment and Supplies fee schedule (updated May 10, 2021)
• October 1, 2020 to December 31, 2020 — Medical Equipment and Supplies fee schedule (updated November 2, 2020)
• July 1, 2020 to September 30, 2020 — Medical Equipment and Supplies fee schedule (updated August 3, 2020)
• View all medical equipment and supplies fee schedules

Social Services

• Social services supplement (updated October 1, 2020)
• November 17, 2020 to present - Social services blanket codes
• May 22, 2020 to November 16, 2020 — Social services blanket codes
• View all social services blanket codes

Billing guides

• 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

Fee schedules

• July 1, 2020 to present — Medical nutrition therapy (published July 1, 2020)
• July 1, 2019 to June 30, 2020 — Medical nutrition therapy (published June 24, 2019)
• July 1, 2018 to June 30, 2019 — Medical nutrition therapy  (published June 26, 2018)
• View all medical nutrition therapy fee schedules

Social Services

• Social services supplement (updated October 1, 2020)
• November 17, 2020 to present - Social services blanket codes
• May 22, 2020 to November 16, 2020 — Social services blanket codes
• View all social services blanket codes

Billing guides

• April 14, 2021 to present - Mental health services billing guide
• April 1, 2021 to April 13, 2021 - Mental health services billing guide
• January 1, 2021 to March 31, 2021 - Mental health services billing guide
• View all mental health services billing guides

Integrated Managed Care (IMC) Service Encounter Reporting

• SERI instructions and interim guidance

Fee schedules

Mental health services

• January 1, 2021 to present — Mental health and psychology services fee schedule (updated May 10, 2021)
• July 1, 2020 to December 31, 2020 — Mental health and psychology services fee schedule (updated October 20, 2020)
• April 1, 2020 to June 30, 2020 — Mental health and psychology services fee schedule (published March 30, 2020)
• View all mental health services fee schedules

Specialized mental health services

• January 1, 2021 to present — Specialized mental health fee schedule (updated February 1, 2021)
• July 1, 2020 to December 31, 2020 — Specialized mental health fee schedule (published June 30, 2020)
• January 1, 2020 to June 30, 2020 — Specialized mental health fee schedule (published April 13, 2020)
• View all specialized mental health services fee schedules

Additional materials

• How do providers identify the correct payer?

Billing guides

• January 1, 2021 to present — Neurodevelopmental centers billing guide
• October 1, 2020 to December 31, 2020 — Neurodevelopmental centers billing guide
• April 1, 2020 to September 30, 2020 — Neurodevelopmental centers billing guide
• View all neurodevelopmental centers billing guides

Fee schedules

• January 1, 2021 to present — Neurodevelopmental centers fee schedule (updated January 4, 2021)
• July 1, 2020 to December 31, 2020 — Neurodevelopmental centers fee schedule (updated August 3, 2020)
• April 1, 2020 to June 30, 2020 — Neurodevelopmental centers fee schedule (published March 26, 2020)
• View all neurodevelopmental centers fee schedules

Billing guides

• April 1, 2019 to present — Refer to the Medical Equipment and Supplies billing guide for information regarding durable medical 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

Fee schedules

• January 1, 2019 to March 31, 2019 — Nondurable medical supplies and equipment fee schedule (published January 23, 2019)
• January 1, 2018 to December 31, 2018 — Nondurable medical supplies and equipment fee schedule (published December 29, 2017)
• View all nondurable medical supplies and equipment fee schedules

Billing guides

• 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

Billing guides

• April 1, 2021 to present — Orthodontic service billing guide
• October 1, 2020 to March 31, 2021 — Orthodontic service billing guide
• February 8, 2020 to September 30, 2020 — Orthodontic service billing guide
• View all orthodontic services billing guides

Fee schedules

See Dental Program.

Billing guides

• April 1, 2021 to present — Outpatient hospital services billing guide
• January 1, 2021 to March 31, 2021 — Outpatient hospital services billing guide
• October 1, 2020 to December 31, 2020 — Outpatient hospital services billing guide
• View all outpatient billing guides

Fee schedules

• April 1, 2021 to present — OPPS fee schedule (updated May 6, 2021)
• January 1, 2021 to March 31, 2021 — OPPS fee schedule (updated March 9, 2021)
• October 1, 2020 to December 31, 2020 — OPPS fee schedule (updated February 3, 2021)
• July 1, 2020 to September 30, 2020 — OPPS fee schedule (updated February 17, 2021)
• View all outpatient fee schedules

Additional information

• HCA revenue code grids
• Guidance for billing MCOs for services provided to newborns

Billing guides

• 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

Fee schedules

• January 1, 2021 to present — Outpatient rehabilitation fee schedule (updated January 4, 2021)
• July 1, 2020 to December 31, 2020 — Outpatient rehabilitation fee schedule (published June 29, 2020)
• April 1, 2020 to June 30, 2020 — Outpatient rehabilitation fee schedule (published March 26, 2020)
• View all Outpatient Rehabilitation Program fee schedules

Social Services 

• Social services supplement (updated October 1, 2020)
• November 17, 2020 to present - Social services blanket codes
• May 22, 2020 to November 16, 2020 - Social services blanket codes
• View all social services blanket codes

Fee schedules

• July 1, 2020 to present — Pharmacy Special Services fee schedule (published June 29, 2020)
• July 1, 2019 to June 30, 2020 — Pharmacy Special Services fee schedule (published June 21, 2019)
• July 1, 2018 to June 30, 2019 — Pharmacy Special Services fee schedule (updated July 30, 2018)
• View all pharmacy special services fee schedules

Billing guides

• May 6, 2021 to present — Physician-related services/health care billing guide
• April 1, 2021 to May 5, 2021 — Physician-related services/health care billing guide
• March 5, 2021 to March 31, 2021 — Physician-related services/health care billing guide
• View all physician-related/professional services billing guides

Physician-related/professional services fee schedules

• April 1, 2021 to present — Physician-related services fee schedules (updated May 3, 2021)
• January 1, 2021 to March 31, 2021 — Physician-related services fee schedules (updated March 25, 2021)
• October 1, 2020 to December 31, 2020 — Physician-related services fee schedule (updated November 24, 2020)
• View all physician-related/professional services fee schedules

Enhanced pediatric fee schedules

• January 1, 2021 to present — Enhanced pediatric fee schedule (published December 23, 2020)
• July 1, 2020 to December 31, 2020 — Enhanced pediatric fee schedule (updated October 27, 2020)
• January 1, 2020 to June 30, 2020 — Enhanced pediatric fee schedule (published December 31, 2019)
• View all enhanced pediatric fee schedules

Medication for Opioid Use Disorder fee schedules

• January 1, 2021 to present — Opioid Use Disorder fee schedule (published December 23, 2020)
• July 1, 2020 to December 31, 2020 — Opioid Use Disorder fee schedule (published June 29, 2020)
• July 1, 2019 to June 30, 2020 — Opioid Use Disorder fee schedule (published June 24, 2019)
• View all medication for opioid use disorder fee schedules

Conversion factors

• July 1, 2020 to present — Conversion factors (published June 30, 2020)
• July 1, 2019 to June 30, 2020 — Conversion factors (published June 24, 2019)
• July 1, 2018 to June 30, 2019 — Conversion factors (published June 29, 2018)
• View all conversion factors

Additional materials

• Hysterectomy Form [13-365]
• Sterilization Supplemental Billing Guide
• Family Planning Billing Guide
• Guidance for billing MCOs for services provided to newborns

Billing guides

• May 1, 2021 to present — Planned home births and births in centers billing guide
• January 1, 2021 to April 30, 2021 — 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
• View all planned home births billing guides

Fee schedules

• July 1, 2020 to present — Planned home births and births in centers fee schedule (updated July 27, 2020)
• April 1, 2020 to June 30, 2020 — Planned home births and births in centers fee schedule (published April 2, 2020)
• October 25, 2019 to March 31, 2020 — Planned home births and births in centers fee schedule (published November 4, 2019)
• 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.)

• View all Prenatal genetic counseling  billing guides

Fee schedules

• July 1, 2020 to present — Prenatal diagnosis genetic counseling fee schedule (published June 30, 2020)
• July 1, 2017 to June 30, 2020 — Prenatal diagnosis genetic counseling fee schedule (published June 29, 2017)

Billing guides

• March 14,  2021 to present - Prescription drug program billing guide
• January 1, 2021 to March 13, 2021 - Prescription drug program billing guide
• October 1, 2020 to December 31, 2020 - Prescription drug program billing guide
• View all billing guides

Apple Health (Medicaid) expedited authorization (EA) lists

• March 1, 2021 to present - Expedited authorization codes and criteria table
• December 1, 2020 to February 28, 2021 - Expedited authorization codes and criteria table
• July 1, 2020 to November 30, 2020 — Expedited authorization codes and criteria table
• View all 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

• Current SMAC list

To request an FFS change in reimbursement

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

Billing guides

• 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

Fee schedules

• January 1, 2020 to present — Private duty nursing fee schedule (published December 19, 2019)
• July 1, 2016 to December 31, 2019 — Private duty nursing fee schedule (published June 22, 2016)

Social Services

• Social services supplement (updated October 1, 2020)
• View all social services blanket codes

Fee schedules

• April 1, 2021 to present — Professional administered drug fee schedule (updated May 6, 2021)
• January 1, 2021 to March 31, 2021 — Professional administered drug fee schedule (updated March 4, 2021)
• October 1, 2020 to December 31, 2020 — Professional administered drug fee schedule (updated November 5, 2020)
• View all professional administered drugs fee schedules

Billing guides

• 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

Fee schedules

• October 1, 2020 to present — Prosthetic and orthotics fee schedule (published September 28, 2020)
• July 1, 2020 to September 30, 2020 — Prosthetic and orthotics fee schedule (published July 1, 2020)
• January 1, 2020 to June 30, 2020 — Prosthetic and orthotics fee schedule (published December 31, 2019)
• View all prosthetic and orthotics fee schedules

Social Services

• Social services supplement (updated October 1, 2020)
• November 17, 2020 to present - Social services blanket codes
• May 22,  2020 to November 16, 2020 — Social services blanket codes
• View all social services blanket codes

Billing guides

• 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
• View all respiratory care billing guides

Fee schedules

• October 1, 2020 to present — Respiratory care fee schedule (published September 28, 2020)
• July 1, 2020 to September 30, 2020 — Respiratory care fee schedule (published June 29, 2020)
• April 1, 2020 to June 30, 2020 — Respiratory care fee schedule (published April 28, 2020)
• View all respiratory care fee schedules

Social Services

• Social services supplement (updated October 1, 2020)
• November 17, 2020 to present - Social services blanket codes
• May 22, 2020 to November 16, 2020 — Social services blanket codes
• View all social services blanket codes

Billing guides

• May 11, 2021 to present — Rural health clinics billing guide
• April 1, 2021 to present — Rural health clinics billing guide
• January 1, 2021 to March 31, 2021 — Rural health clinics billing guide
• View all RHC billing guides

Encounter rates

• April 1, 2021 to present — Encounter rates (updated April 6, 2021)
• January 1, 2021 to March 31, 2021 — Encounter rates (updated April 6, 2021)
• October 1, 2020 to December 31, 2020 — Encounter rates (updated March 24, 2021)
• View all encounter rates

Enhancement rates

• April 1, 2021 to present — RHC enhancement rates (updated May 6, 2021)
• January 1, 2021 to March 31, 2021 — RHC enhancement rates (updated May 6, 2021)
• October 1, 2020 to December 31, 2020 — RHC enhancement rates (updated May 6, 2021)
• View all enhancement rates

Billing guides

• 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
• View all SBHS billing guides

Fee schedules

• July 1, 2020 to present — SBHS fee schedule (published June 29, 2020)
• January 1, 2020 to June 30, 2020 — SBHS fee schedule (published December 31, 2019)
• July 1, 2019 to December 31, 2019 — SBHS fee schedule (published June 24, 2019)
• View all SBHS fee schedules

Billing guides

• 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
• View all sleep centers billing guides

Fee schedules

• July 1, 2020 to present — Sleep centers fee schedule (published June 30, 2020)
• January 1, 2020 to June 30, 2020 — Sleep centers fee schedule (published January 15, 2020)
• July 1, 2019 to December 31, 2019 — Sleep centers fee schedule (published July 1, 2019)
• View all sleep centers fee schedules

Billing guides

• 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
• View all sterilization billing guides

Fee schedules

See Physician-related/professional services

Additional materials

• Family Planning Billing Guide
• Physician-related/Professional Services Billing Guide
• Sterilization Consent Form (HHS-687) (English)
• Sterilization Consent Form (HHS-687-1) (Spanish)

Billing guides

• April 1, 2021 to present — Substance use disorder billing guide
  (Fee-for-service benefits provided outside of the BHO process)
• January 1, 2021 to March 31, 2021 — Substance use disorder billing guide
  (Fee-for-service benefits provided outside of the BHO process)
• August 1, 2020 to December 31, 2020 — Substance use disorder billing guide
• (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

• January 1, 2021 to present — Substance use disorder fee schedule (updated January 21, 2021)

• October 1, 2020 to December 31, 2020 — Substance use disorder fee schedule (updated January 21, 2020)

• January 1, 2020 to September 30, 2020 — Substance use disorder fee schedule (updated January 8, 2020)

• View all substance use disorder fee schedules

Fiscal program requirements

• Fiscal program requirements for SUD

Billing guides

• April 1, 2021 to present — Tribal health billing guide
• January  1, 2021 to March 31, 2021 — Tribal health billing guide
• October  1, 2020 to December 30, 2020 — Tribal health billing guide
• View all Tribal Health Program billing guides

Fee schedules

• January 1, 2021 to present — Tribal health program fee schedule (published January 5, 2021)
• April 1, 2020 to December 31, 2020 — Tribal health program fee schedule (updated May 6, 2020)
• January 1, 2020 to March 31, 2020 — Tribal health program fee schedule (updated April 24, 2020)
• View all tribal health fee schedules

Billing guides

• 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
• 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.