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 concerning past versions of billing guides

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

On this page

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.

For questions about billing guides

Contact Medical Assistance Customer Service Center (MACSC) online or at 1-800-562-3022. For questions about rates or fee schedules, email HCA Professional Rates.

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

- A -

Access to baby and child dentistry/Mouth Matters (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

Additional materials

Ambulatory surgery centers (ASCs)

Billing guides

Fee schedules

Applied behavior analysis (ABA)

Billing guides

Fee schedules

Centers of Excellence

- B -

Birth doula services

Billing guides

Fee schedules

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

- C -

Chemical-Using Pregnant (CUP) Program

Billing guides

Fee schedule (reimbursement/rates)

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

Additional information

Childbirth education

Billing guides

Fee schedules

Chiropractic services for children

Billing guides

Fee schedules

Community Behavioral Health Support (CBHS) services

Billing guides

Fee schedules

Community Health Worker (CHW) services

Billing guides

Fee schedules

Complex rehabilitation technology (CRT)

Billing guides

Fee schedules

Social services (see appropriate fee schedule for rate)

COVID-19

Fee schedules

Policies and billing guidance

Apple Health COVID-19 vaccine policy

Effective October 1, 2024, this guide has been discontinued. Please refer to the EPSDT Well-Child Program Billing Guide, and the Physician-Related Services/Health Care Professional Services Guide for immunization/vaccine policies.

Apple Health Monoclonal Antibody Treatment COVID-19 clinical policy

Apple Health COVID-19 testing clinical policy

Effective February 1, 2024, this guide has been discontinued. Please refer to individual program billing guides for COVID-19 testing clinical policy.

- D -

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 (Pilot project ended 12/31/2023)

Mobile anesthesia

Fee schedules

Diabetes Education Program

Billing guides

Fee schedules

Durable medical equipment (DME)

Billing guides

Additional materials

- E -

Early Periodic Screening, Diagnosis, and Treatment (EPSDT)

Billing guides

Fee schedules

Enteral nutrition

Billing guides

Fee schedules

- F -

Family planning

Billing guides

Family planning fee schedules

SRHP fee schedules

Additional materials

Family planning

Federally qualified health centers (FQHCs)

Billing guides

Encounter rates

Enhancement rates

- H -

Habilitative services

Billing guides

Fee schedules

Health-related social needs (HRSN)

The Health-Related Social Needs (HRSN) Services and In Lieu of Services (ILOS) Policy Guide provides information on new HRSN services available to people enrolled in Apple Health (Medicaid). Enrollees can receive these services through:

  • ILOS – for managed care enrollees, or
  • Through our state’s Section 1115 Medicaid demonstration waiver (called the Medicaid Transformation Project (MTP)) – for fee-for-service enrollees.

This guide explains when an HRSN service can be offered and the process that the Health Care Authority (HCA), MCOs, and providers must follow. For questions, please contact our MTP team.

Policy guides

Hearing services

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

Billing guides

Fee schedules

Social services (see appropriate fee schedule for rate)

HIV/AIDS case management

Billing guides

Fee schedules

Home health services (acute care services)

Billing guides

Fee schedules

Home infusion therapy/parenteral nutrition

Billing guides

Fee schedules

Social services (see appropriate fee schedule for rate)

Hospice

Billing guides

Fee schedules

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.

- I -

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

- K -

Kidney center services

Billing guides

Fee schedules

- L -

Long term acute care

Billing guides

- M -

Maternity support services/infant case management (MSS/ICM)

Billing guides

Fee schedules

Medical equipment and supplies

Billing guides

Fee schedules

Social services (see appropriate fee schedule for rate)

Medical nutrition therapy

Billing guides

Fee schedules

Social services (see appropriate fee schedule for rate)

Mental health services

Billing guides

Integrated Managed Care (IMC) Service Encounter Reporting

Fee schedules

Evaluation and treatment centers

Mental health services

Specialized mental health services

Additional materials

- N -

Neurodevelopmental centers

Billing guides

Fee schedules

Nondurable medical supplies and equipment

Billing guides

Nursing facilities

Billing guides

- O -

Orthodontic services

Billing guides

Fee schedules

See Dental Program.

Outpatient hospital

Billing guides

Fee schedules

Additional information

Outpatient Rehabilitation Program

Billing guides

Fee schedules

Social services (see appropriate fee schedule for rate)

- P -

Pharmacy special services, vaccine administration, and compliance packaging

Fee schedules

Physician-related/professional services

Billing guides

Pregnancy related services have been moved to the Pregnancy related services billing guide

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

Planned home births and births in birth centers

Billing guides

Fee schedules

Pregnancy-related services

Billing guides

Fee schedule

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.)

Fee schedules

(Effective October 1, 2024 these fee schedules were merged into the physician-related services/health care professional services fee schedule. See Physician-related/professional services)

Prescription Drug Program

Billing guides

Apple Health (Medicaid) expedited authorization (EA) lists

For previous versions, email us Apple Health Pharmacy Policy.

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: 833-991-0704.

Private duty nursing

Billing guides

Fee schedules

Social services

Professional administered drugs

Fee schedules

Prosthetics and orthotics

Billing guides

Fee schedules

Social services (see appropriate fee schedule for rate)

- R -

Reentry services

Billing guides

Targeted case management fee schedule

Reentry initiative covered procedure code list

Respiratory care

Billing guides

Fee schedules

Social services (see appropriate fee schedule for rate)

Rural health clinics (RHCs)

Billing guides

Encounter rates

Enhancement rates

- S -

School-based health care services (SBHS)

Billing guides

Fee schedules

Sleep centers

Billing guides

Fee schedules

Centers of Excellence

Sterilization

Billing guides

Fee schedules

See Physician-related/professional services

Additional materials

Substance Use Disorder Program

Billing guides

Substance Use Disorder fee schedules

Problem Gambling fee schedules

Substance-Using Pregnant People (SUPP) Program

Billing guides

Fee schedule (reimbursement/rates)

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

Additional information

- T -

Telehealth

Telemedicine policy and billing

Physical health

Behavioral health

Audio-only telemedicine

Physical health audio-only procedure codes

Behavioral health audio-only procedure codes

Telehealth services billing guide audio only supplement

COVID-19 public health emergency policies

Clinical policy and billing for COVID-19 — Effective January 1, 2024, see program-specific billing guides

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

Behavioral health policy and billing

Effective July 1, 2023, see Apple Health (Medicaid) FAQ for behavioral health providers billing for services provided via telemedicine

See Behavioral health under Telemedicine policy and billing for all versions of this policy

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

Transhealth Program

Billing guides

Fee schedules

Tribal Health Program

Billing guides

Fee schedules

- V -

Vision hardware for clients 20 years of age and younger

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: HCA Professional Rates

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

Related forms and publications

Related links