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.
Stay up-to-date with rate and billing changes, and ProviderOne system changes.
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.
Billing guides and fee schedules
Use our billing guides and fee schedules to determine if a PA is required and assist in filing claims.
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 (ABCD)
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Billing guides
Fee schedules
See Dental Program.
- Acute physical medicine and rehabilitation
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Billing guides
- Alien Medical Program emergency assistance
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Billing guides
- Ambulance transportation
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Billing guides
Ambulance transportation
Ground Emergency Medical Transportation (GEMT)
Fee schedules
- July 1, 2023 to present — Ambulance transportation (published July 12, 2023)
- July 1, 2021 to June 30, 2023 — Ambulance transportation (updated March 17, 2022)
- 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)
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Billing guides
Fee schedules
- October 1, 2023 to present — ASC fee schedule (updated November 27, 2023)
- April 1, 2023 to September 30, 2023 — ASC fee schedule (updated September 8, 2023)
- October 1, 2022 to March 31, 2023 — ASC fee schedule (updated May 16, 2023)
- April 1, 2022 to September 30, 2022 — ASC fee schedule (updated August 12, 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)
- View all ASC fee schedules
- Applied behavior analysis (ABA)
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Billing guides
Fee schedules
Centers of Excellence
- B -
- Blood bank services
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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
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Billing guides
Fee schedule (reimbursement/rates)
See Inpatient Prospective Payment System (IPPS) on the Hospital reimbursement page.
Additional information
- Childbirth education
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Billing guides
Fee schedules
- Chiropractic services for children
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Billing guides
Fee schedules
- Complex rehabilitation technology (CRT)
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Billing guides
Fee schedules
Social services (see appropriate fee schedule for rate)
- COVID-19
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Fee schedules
Policies and billing guidance
Apple Health COVID-19 vaccine policy
Apple Health Monoclonal Antibody Treatment COVID-19 clinical policy
- August 17, 2023 to present — Apple Health Monoclonal Antibody Treatment COVID-19 clinical policy: Medical policy no. 19.50.20
- April 24, 2023 to August 16, 2023 — Apple Health Monoclonal Antibody Treatment COVID-19 clinical policy: Medical policy no. 19.50.20
- December 16, 2022 to April 23, 2023 — Therapies for COVID-19: Medical policy no. 19.50.20
- September 14, 2022 to December 15, 2022 — Therapies for COVID-19: Medical policy no. 19.50.20
- August 19, 2022 to September 13, 2022 — Therapies for COVID-19: Medical policy no. 19.50.20
- May 10, 2022 to August 18, 2022 — Therapies for COVID-19: Medical policy no. 19.50.20
- April 12, 2022 to May 9, 2022 — Therapies for COVID-19: Medical policy no. 19.50.20
- March 23, 2022 to April 11, 2022 — Therapies for COVID-19: Medical policy no. 19.50.20
- View all Monoclonal Antibody Treatment COVID-19 clinical policies
Apple Health COVID-19 testing clinical policy
- D -
- Dental Program
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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
- Diabetes Education Program
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Billing guides
Fee schedules
- Durable medical equipment (DME)
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Billing guides
Additional materials
- E -
- Early and periodic screening, diagnosis and treatment (EPSDT)
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Billing guides
Fee schedules
Periodicity schedules
- Enteral nutrition
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Billing guides
Fee schedules
- F -
- Family planning
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Billing guides
Family planning fee schedules
SRHP fee schedules
Additional materials
Family planning
- Federally qualified health centers (FQHCs)
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Billing guides
Encounter rates
Enhancement rates
- H -
- Habilitative services
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Billing guides
Fee schedules
- Health-related social needs (HRSN)
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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 hardware
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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
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Billing guides
Fee schedules
- Home health services (acute care services)
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Billing guides
Fee schedules
- Home infusion therapy/parenteral nutrition
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Billing guides
Fee schedules
Social services (see appropriate fee schedule for rate)
- Hospice
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Billing guides
Fee schedules
- Hospital-based inpatient detoxification
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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
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Billing guides
Fee schedule (reimbursement/rates)
See Inpatient Prospective Payment System (IPPS) on the Hospital reimbursement page.
Additional information
- Interpreter services
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Billing guides
- K -
- Kidney center services
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Billing guides
Fee schedules
- L -
- Long term acute care
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Billing guides
- M -
- Maternity support services/infant case management (MSS/ICM)
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Billing guides
Fee schedules
- Medical equipment and supplies
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Billing guides
Fee schedules
Social services (see appropriate fee schedule for rate)
- Medical nutrition therapy
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Billing guides
Fee schedules
Social services (see appropriate fee schedule for rate)
- Mental health services
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Billing guides
Integrated Managed Care (IMC) Service Encounter Reporting
Fee schedules
Mental health services
Specialized mental health services
Additional materials
- N -
- Neurodevelopmental centers
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Billing guides
Fee schedules
- Nondurable medical supplies and equipment
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Billing guides
- Nursing facilities
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Billing guides
- O -
- Orthodontic services
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Billing guides
Fee schedules
See Dental Program.
- Outpatient hospital
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Billing guides
Fee schedules
- October 1, 2023 to present — OPPS fee schedule (updated November 20, 2023)
- July 1, 2023 to September 30, 2023 — OPPS fee schedule (updated November 6, 2023)
- April 1, 2023 to June 30, 2023 — OPPS fee schedule (updated July 3, 2023)
- January 1, 2023 to March 31, 2023 — OPPS fee schedule (updated June 21, 2023)
- October 1, 2022 to December 31, 2022 — OPPS fee schedule (updated July 27, 2023)
- View all outpatient fee schedules
Additional information
- Outpatient Rehabilitation Program
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Billing guides
Fee schedules
Social services (see appropriate fee schedule for rate)
- P -
- Pharmacy special services, vaccine administration, and compliance packaging
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Fee schedules
- Physician-related/professional services
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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
- Planned home births and births in birth centers
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Billing guides
Fee schedules
- Prenatal diagnosis genetic counseling
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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
- Prescription Drug Program
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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.
- Private duty nursing
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Billing guides
Fee schedules
Social services
- Professional administered drugs
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Fee schedules
- Prosthetics and orthotics
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Billing guides
Fee schedules
Social services (see appropriate fee schedule for rate)
- R -
- Respiratory care
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Billing guides
Fee schedules
Social services (see appropriate fee schedule for rate)
- Rural health clinics (RHCs)
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Billing guides
Encounter rates
Enhancement rates
- S -
- School-based health care services (SBHS)
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Billing guides
Fee schedules
- Sleep centers
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Billing guides
Fee schedules
Centers of Excellence
- Sterilization
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Billing guides
Fee schedules
See Physician-related/professional services
Additional materials
- Substance Use Disorder Program
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Billing guides
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
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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
- July 1, 2023 to present — Clinical policy for COVID-19
- May 12, 2023 to June 30, 2023 — Clinical policy for COVID-19
- August 1, 2022 to May 11, 2023 — Apple Health (Medicaid) clinical policy and billing for COVID-19
- July 22, 2022 to July 31, 2022 — Apple Health (Medicaid) clinical policy and billing
- February 1, 2022 to July 21, 2022 — Apple Health (Medicaid) clinical policy and billing
- January 1, 2022 to January 31, 2022 — Apple Health (Medicaid) clinical policy and billing
- View all clinical policy and billing FAQs
Telemedicine/telehealth brief — Effective January 1, 2022 see 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
- July 1, 2023 to September 30, 2023 — Telehealth requirements for physical, occupational, and speech therapy
- July 22, 2022 to June 30, 2023 — Telehealth requirements for physical, occupational and speech therapy
- February 1, 2022 to July 21, 2022 — Telehealth requirements for physical, occupational and speech therapy
- View all 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
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Billing guides
Fee schedules
- Tribal Health Program
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Billing guides
Fee schedules
- V -
- Vision hardware for clients 20 years of age and younger
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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
