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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.

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.

Don't see what you're looking for?

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)

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

Access to baby and child dentistry (ABCD)

Billing guides

Fee schedules

See Dental Program.

Acute physical medicine and rehabilitation

Billing guides

Alien Medical Program emergency assistance

Billing guides

Ambulance transportation

Billing guides

Ambulance transportation

Ground Emergency Medical Transportation (GEMT)

Fee schedules

July 1, 2021 to present — Ambulance transportation (updated August 12, 2021)
February 29, 2020 to June 30, 2021 — 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

Ambulatory surgery centers (ASCs)

Billing guides

Fee schedules

April 1, 2022 to present -- ASC fee schedule (updated May 5, 2022)
October 1, 2021 to March 31, 2022 -- ASC fee schedule (updated December 16, 2021)
March 1, 2021 to September 30, 2021 -- ASC fee schedule (updated June 8, 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

Applied behavior analysis (ABA)

Billing guides

Fee schedules

July 1, 2021 to present— ABA fee schedule (published June 30, 2021)
July 1, 2020 to June 30, 2021 — ABA fee schedule (published June 29, 2020)
July 1, 2019 to June 30, 2020 — ABA fee schedule (published June 24, 2019)
View all ABA fee schedules

Centers of Excellence

ABA COE fee-for-service provider directory

Blood bank services

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, 2021 to present— Blood bank fee schedule (published July 1, 2021)
July 1, 2020 to June 30, 2021 — Blood bank fee schedule (published June 30, 2020)
July 1, 2019 to June 30, 2020 — Blood bank fee schedule (published July 1, 2019)
View all Blood Bank services fee schedules

Chemical-Using Pregnant (CUP) Program

Billing guides

Fee schedule (reimbursement/rates)

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

Additional information

HCA revenue code grids

Childbirth education

Billing guides

Fee schedules

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

Chiropractic services for children

Billing guides

Fee schedules

July 1, 2021 to present— Chiropractic services for children (published June 30, 2021)
July 1, 2020 to June 30, 2021 — Chiropractic services for children (updated March 15, 2021)
July 1, 2019 to June 30, 2020 — Chiropractic services for children (published June 24, 2019)

Complex rehabilitation technology (CRT)

Billing guides

Fee schedules

April 1, 2022 to present — CRT fee schedule (published March 30, 2022)
July 1, 2021 to March 31, 22 — CRT fee schedule (updated November 3, 2021)
July 1, 2020 to June 30, 2021 — CRT fee schedule (published June 29, 2020)
View all CRT fee schedules

Social Services

COVID-19

Fee schedules

January 1, 2022 to present — COVID-19 fee schedule (updated April 18, 2022)
July 1, 2021 to December 31, 2021 — COVID-19 fee schedule (updated November 4, 2021)
April 1, 2021 to June 30, 2021 — COVID-19 fee schedule (updated June 28, 2021)
View all COVID-19 fee schedules

Policies and billing guidance

Apple Health COVID-19 vaccine policy

Apple Health Monoclonal Antibody Treatment COVID-19 clinical policy

Apple Health COVID-19 testing clinical policy

Dental Program

Billing guides

Access to Baby and Child Dentistry (ABCD)

See Access to Baby and Child Dentistry (ABCD).

Dental-related services

Oral Health Connections (OHC) pilot project

Mobile anesthesia

Fee schedules

January 1, 2022 to present — Dental program fee schedule (updated December 29, 2021)
July 1, 2021 to December 31, 2021 — Dental program fee schedule (updated August 3, 2021)
April 1, 2021 to June 30, 2021 — Dental program fee schedule (published March 31, 2021)
View all dental services fee schedules

Diabetes Education Program

Billing guides

Fee schedules

July 1, 2021 to present — Diabetes education (published June 30, 2021)
July 1, 2020 to June 30, 2021 — Diabetes education (published June 29, 2020)
July 1, 2019 to June 30, 2020 — Diabetes education (published June 24, 2019)

Durable medical equipment (DME)

Early and periodic screening, diagnosis and treatment (EPSDT)

Billing guides

Fee schedules

July 1, 2021 to present — EPSDT fee schedule (published June 30, 2021)
July 1, 2020 to June 30, 2021 — EPSDT fee schedule (published June 29, 2020)
January 1, 2020 to June 30, 2020 — EPSDT fee schedule (published December 31, 2019)
View all EPSDT fee schedules

Periodicity schedules

EPSDT periodicity schedule (Updated April 1, 2021)

Enteral nutrition

Billing guides

Fee schedules

July 1, 2021 to present — Enteral nutrition fee schedule (updated November 3, 2021)
July 1, 2020 to June 30, 2021 — Enteral nutrition fee schedule (updated July 21, 2020)
January 1, 2019 to June 30, 2020 — Enteral nutrition fee schedule (published November 6, 2019)

Family planning

Billing guides

Family planning fee schedules

January 1, 2022 to present — Family planning fee schedule (updated February 7, 2022)
October 1, 2021 to December 31, 2021 — Family planning fee schedule (updated October 5, 2021)
July 1, 2021 to September 30, 2021 — Family planning fee schedule (updated October 22, 2021)
View all family planning fee schedules

SRHP fee schedules

October 1, 2021 to present — SRHP fee schedule (updated April 4, 2022)

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)

Federally qualified health centers (FQHCs)

Billing guides

Encounter rates

April 1, 2022 to present — FQHC encounter rates (updated April 19, 2022)
January 1, 2022 to March 31, 2022 — FQHC encounter rates (updated April 19, 2022)
October 1, 2021 to December 31, 2021 — FQHC encounter rates (updated April 19, 2022)
View all encounter rates

Enhancement rates

April 1, 2022 to present — FQHC enhancement rates (updated April 13, 2022)
January 1, 2022 to March 31, 2022 — FQHC enhancement rates (updated April 13, 2022)
October 1, 2021 to December 31, 2021 — FQHC enhancement rates (updated May 10, 2022)
View all enhancement rates

Habilitative services

Billing guides

Fee schedules

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

Hearing hardware

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

Billing guides

Fee schedules

April 1, 2022 to present — Hearing hardware fee schedule (published March 30, 2022)
July 1, 2021 to March 30, 2022 — Hearing hardware fee schedule (published July 8, 2021)
October 1, 2020 to June 30, 2021 — Hearing hardware fee schedule (published September 28, 2020)
View all hearing hardware fee schedules

Social Services

HIV/AIDS case management

Billing guides

Fee schedules

July 1, 2018 to present — HIV/AIDS case management (Published June 26, 2018)

Home health services (acute care services)

Billing guides

Fee schedules

January 1, 2022 to present — Home health fee schedule (updated January 31, 2022)
July 1, 2021 to December 31, 2021 — Home health fee schedule (updated October 12, 2021)
January 1, 2021 to June 30, 2021 — Home health fee schedule (published February 1, 2021)
View all home health services fee schedules

Home infusion therapy/parenteral nutrition

Billing guides

Fee schedules

July 1, 2021 to present — Home infusion therapy/parenteral nutrition fee schedule (updated April 1, 2022)
January 1, 2021 to June 30, 2021 — 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)
View all home infusion therapy/parenteral nutrition fee schedules

Social Services

Hospice

Billing guides

Fee schedules

October 1, 2021 to present — Hospice fee schedule (published September 29, 2021)
October 1, 2020 to September 30, 2021 — Hospice fee schedule (published September 21, 2020)
October 1, 2019 to September 30, 2020 — Hospice fee schedule (published September 30, 2019)

Hospital-based inpatient detoxification

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.

Inpatient hospital

Billing guides

Fee schedule (reimbursement/rates)

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

Additional information

Interpreter services

Billing Guides

Kidney center services

Billing guides

Fee schedules

April 1, 2022 to present — Kidney centers fee schedules (published March 29, 2022)
January 1, 2022 to March 31, 2022 — Kidney centers fee schedules (published December 29, 2021)
October 1, 2021 to December 31, 2021 — Kidney centers fee schedules (published September 29, 2021)
View all kidney center services fee schedules

Long term acute care

Billing guides

Maternity support services/infant case management (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)

Medical equipment and supplies

Billing guides

Fee schedules

January 1, 2022 to present — Medical Equipment and Supplies fee schedule (updated January 3, 2022)
October 1, 2021 to December 31, 2021 — Medical Equipment and Supplies fee schedule (updated November 3, 2021)
July 1, 2021 to September 30, 2021 — Medical Equipment and Supplies fee schedule (updated November 3, 2021)
View all medical equipment and supplies fee schedules

Social Services

Medical nutrition therapy

Billing guides

Fee schedules

July 1, 2021 to present — Medical nutrition therapy (published June 30, 2021)
July 1, 2020 to June 30, 2021 — Medical nutrition therapy (published July 1, 2020)
July 1, 2019 to June 30, 2020 — Medical nutrition therapy (published June 24, 2019)

Social Services

Mental health services

Billing guides

Integrated Managed Care (IMC) Service Encounter Reporting

SERI instructions and interim guidance

Fee schedules

Mental health services

January 1, 2022 to present— Mental health and psychology services fee schedule (updated January 10, 2022)
October 1, 2021 to December 31, 2021 — Mental health and psychology services fee schedule (updated January 10, 2022)
July 1, 2021 to September 30, 2021 — Mental health and psychology services fee schedule (updated January 10, 2022)
View all mental health services fee schedules

Specialized mental health services

January 1, 2022 to present — Specialized mental health fee schedule (published April 4, 2022)
October 1, 2021 to December 31, 2021 — Specialized mental health fee schedule (updated November 19, 2021)
July 1, 2021 to September 30, 2021 — Specialized mental health fee schedule (updated November 19, 2021)
View all specialized mental health services fee schedules

Additional materials

How do providers identify the correct payer?

Neurodevelopmental centers

Billing guides

Fee schedules

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

Nondurable medical supplies and equipment

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)

Nursing facilities

Billing guides

Orthodontic services

Billing guides

Fee schedules

See Dental Program.

Outpatient hospital

Billing guides

Fee schedules

April 1, 2022 - present -- OPPS fee schedule (updated May 9, 2022)
January 1, 2022 to March 31, 2022 -- OPPS fee schedule (updated March 21, 2022)
October 1, 2021 to December 31, 2021 -- OPPS fee schedule (updated January 24, 2022)
July 1, 2021 to September 30, 2021 -- OPPS fee schedule (updated August 31, 2021)
April 1, 2021 to June 30, 2021 — OPPS fee schedule (updated November 29, 2021)
January 1, 2021 to March 31, 2021 — OPPS fee schedule (updated November 29, 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

Outpatient Rehabilitation Program

Billing guides

Fee schedules

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

Social Services

Pharmacy special services, vaccine administration, and compliance packaging

Fee schedules

July 1, 2021 to present — Pharmacy Special Services fee schedule (published July 1, 2021)
July 1, 2020 to June 30, 2021 — 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)
View all pharmacy special services fee schedules

Physician-related/professional services

Billing guides

Physician-related/professional services fee schedules

April 1, 2022 to present — Physician-related services fee schedules (updated May 10, 2022)
January 1, 2022 to March 31, 2022 — Physician-related services fee schedules (updated March 8, 2022)
October 1, 2021 to December 31, 2021 — Physician-related services fee schedules (updated December 20, 2021)
View all physician-related/professional services fee schedules

Enhanced pediatric fee schedules

October 1, 2021 to present — Enhanced pediatric fee schedule (published September 29, 2021)
July 1, 2021 to September 30, 2021 — Enhanced pediatric fee schedule (published June 30, 2021)
January 1, 2021 to June 30, 2021 — Enhanced pediatric fee schedule (published December 23, 2020)
View all enhanced pediatric fee schedules

Enhanced adult primary care fee schedules

October 1, 2021 to present — Enhanced adult primary care fee schedule (published September 29, 2021)

Medication for Opioid Use Disorder (MOUD) fee schedules

July 1, 2021 to present — Opioid use disorder fee schedule (published June 30, 2021)
January 1, 2021 to June 30, 2021 — 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)
View all medication for opioid use disorder fee schedules

Conversion factors

July 1, 2021 to present — Conversion factors (published June 30, 2021)
July 1, 2020 to June 30, 2021 — Conversion factors (published June 30, 2020)
July 1, 2019 to June 30, 2020 — Conversion factors (published June 24, 2019)

Additional materials

Planned home births and births in birth centers

Billing guides

Fee schedules

July 1, 2021 to present — Planned home births and births in centers fee schedule (published June 30, 2021)
July 1, 2020 to June 30, 2021 — 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)
View all planned home births fee schedules

Prenatal diagnosis genetic counseling

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.)