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.

Sign up / view Provider Alerts

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

      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

      Billing guides

      Fee schedules

      Other DME
      Standard wheelchairs and accessories

      Additional materials

      For Apple Health clients age 20 and younger and DDA clients age 21 and older.

      Billing guides

      Fee schedules

      Additional materials

      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

      Fee schedules

      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
      Fee-for-service (FFS) 

      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.

      Fee schedules

      Fee schedules (prior to July 1, 2016)

      Billing Guides

      Fee schedules

      Billing guides

      Fee schedules

      Fee schedules (prior to July 1, 2015)

      Contact

      For fee schedule and rate questions
       
      For all other provider questions
      Medical Assistance Customer Service Center (MACSC)
      Online: Web form
      Phone: 1-800-562-3022