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Provider billing guides and fee schedules

Coronavirus (COVID-19) information. For general Apple Health and behavioral health guidance, visit our Information about novel coronavirus (COVID-19) webpage. For telehealth policies and FAQs, see Telehealth on this page.

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.

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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) information. For general Apple Health and behavioral health guidance, visit our Information about novel coronavirus (COVID-19) webpage. For telehealth policies and FAQs, see Telehealth on this page.

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) information. For general Apple Health and behavioral health guidance, visit our Information about novel coronavirus (COVID-19) webpage. For telehealth policies and FAQs, see Telehealth on this page.

Fee schedules

Coronavirus (COVID-19) information. For general Apple Health and behavioral health guidance, visit our Information about novel coronavirus (COVID-19) webpage. For telehealth policies and FAQs, see Telehealth on this page.

Billing guides

Fee schedules

Other DME
Standard wheelchairs and accessories

Additional materials

Coronavirus (COVID-19) information. For general Apple Health and behavioral health guidance, visit our Information about novel coronavirus (COVID-19) webpage. For telehealth policies and FAQs, see Telehealth on this page.

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) information. For general Apple Health and behavioral health guidance, visit our Information about novel coronavirus (COVID-19) webpage. For telehealth policies and FAQs, see Telehealth on this page.

Billing guides

Integrated Managed Care (IMC) Service Encounter Reporting

Fee schedules

Mental health services
Specialized mental health services

Additional materials

Coronavirus (COVID-19) information. For general Apple Health and behavioral health guidance, visit our Information about novel coronavirus (COVID-19) webpage. For telehealth policies and FAQs, see Telehealth on this page.

Billing guides

Physician-related/professional services fee schedules

Enhanced pediatric fee schedules

Enhanced adult primary care fee schedules

Medication for Opioid Use Disorder (MOUD) fee schedules

Conversion factors

Additional materials

Coronavirus (COVID-19) information. For general Apple Health and behavioral health guidance, visit our Information about novel coronavirus (COVID-19) webpage. For telehealth policies and FAQs, see Telehealth on this page.

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) information. For general Apple Health and behavioral health guidance, visit our Information about novel coronavirus (COVID-19) webpage. For telehealth policies and FAQs, see Telehealth on this page.

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) information. For general Apple Health and behavioral health guidance, visit our Information about novel coronavirus (COVID-19) webpage. For telehealth policies and FAQs, see Telehealth on this page.

Billing guides

Fee schedules

COVID-19 Public Health Emergency Policies

Telemedicine/telehealth brief - Effective January 1, 2022 see Clinical policy and billing

Clinical policy and billing

Behavioral health policy and billing

ABA policy and billing

FAQ for diabetes education providers

Home health services billing and policy during COVID-19 pandemic

Telehealth requirements for physical, occupational and speech therapy

Telehealth services in long term care facilities and skilled nursing facilities

Family planning only billing guide telemedicine/telehealth COVID-19

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