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

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.

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 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.

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 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)

Billing guides

Fee schedules

April 1, 2023 to present -- ASC fee schedule (updated June 6, 2023)
October 1, 2022 to present — 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)

Billing guides

Fee schedules

July 1, 2022 to present — ABA fee schedule (updated April 24, 2023)
July 1, 2021 to June 30, 2022 — ABA fee schedule (published June 30, 2021)
July 1, 2020 to June 30, 2021 — ABA fee schedule (published June 29, 2020)
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, 2022 to present — Blood bank fee schedule (published June 29, 2022)
July 1, 2021 to June 30, 2022 — Blood bank fee schedule (published July 1, 2021)
July 1, 2020 to June 30, 2021 — Blood bank fee schedule (published June 30, 2020)
View all Blood Bank services fee schedules

Chemical-Using Pregnant (CUP) Program

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, 2022 to present — Chiropractic services for children fee schedule (published June 29, 2022)
July 1, 2021 to June 30, 2022 — Chiropractic services for children fee schedule (published June 30, 2021)
July 1, 2020 to June 30, 2021 — Chiropractic services for children fee schedule (updated March 15, 2021)
View all chiropractic services for children fee schedules

Complex rehabilitation technology (CRT)

Billing guides

Fee schedules

July 1, 2022 to present — CRT fee schedule (updated February 7, 2023)
April 1, 2022 to June 30, 2022 — CRT fee schedule (published March 30, 2022)
July 1, 2021 to March 31, 22 — CRT fee schedule (updated November 3, 2021)
View all CRT fee schedules

Social services (see appropriate fee schedule for rate)

COVID-19

Fee schedules

May 11, 2023 to present — COVID-19 fee schedule (updated May 24, 2023)
July 1, 2022 to May 10, 2023 — COVID-19 fee schedule (updated April 26, 2023)
January 1, 2022 to June 30, 2022 — COVID-19 fee schedule (updated May 26, 2022)
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

July 1, 2022 to present — Mobile anesthesia for dental services billing guide

Fee schedules

January 1, 2023 to present — Dental program fee schedule (updated January 26, 2023)
October 1, 2022 to December 31, 2022 — Dental program fee schedule (published October 3, 2022)
July 1, 2022 to September 30, 2022 — Dental program fee schedule (published June 29, 2022)
View all dental services fee schedules

Diabetes Education Program

Billing guides

Fee schedules

July 1, 2022 to present — Diabetes education (published June 29, 2022)
July 1, 2021 to June 30, 2022 — Diabetes education (published June 30, 2021)
July 1, 2020 to June 30, 2021 — Diabetes education (published June 29, 2020)
View all diabetes education fee schedules

Durable medical equipment (DME)

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 — DME and non-CRT wheelchairs billing guide
October 1, 2018 to December 31, 2018 — DME and non-CRT wheelchairs billing guide
July 1, 2018 to September 30, 2018 — DME and non-CRT wheelchairs billing guide
View all DME billing guides

Fee schedules

April 1, 2019 to present — Refer to the Medical Equipment and Supplies fee schedules

Other DME

January 1, 2019 to March 31, 2019 — Other DME fee schedule (updated December 3, 2019)

Standard wheelchairs and accessories

January 1, 2019 to March 31, 2019 — Wheelchairs and accessories fee schedule (updated December 3, 2019)

Additional materials

View all DME social services blanket codes

Early and periodic screening, diagnosis and treatment (EPSDT)

Billing guides

Fee schedules

July 1, 2022 to present — EPSDT fee schedule (updated August 2, 2022)
July 1, 2021 to June 30, 2022 — EPSDT fee schedule (published June 30, 2021)
July 1, 2020 to June 30, 2021 — EPSDT fee schedule (published June 29, 2020)
View all EPSDT fee schedules

Periodicity schedules

EPSDT periodicity schedule (Updated April 1, 2021)

Enteral nutrition

Billing guides

Fee schedules

March 1, 2023 to present — Enteral nutrition fee schedule (posted February 27, 2023)
July 1, 2022 to February 28, 2023 — Enteral nutrition fee schedule (updated July 5, 2022)
July 1, 2021 to June 30, 2022 — Enteral nutrition fee schedule (updated November 3, 2021)
View all enteral nutrition fee schedules

Family planning

Billing guides

Family planning fee schedules

January 1, 2023 to present — Family planning fee schedule (updated May 16, 2023)
October 1, 2022 to December 31, 2022 — Family planning fee schedule (updated December 27, 2022)
July 1, 2022 to September 30, 2022 — Family planning fee schedule (published June 29, 2022)
View all family planning fee schedules

SRHP fee schedules

July 1, 2022 to present — SRHP fee schedule (updated May 16, 2023)
October 1, 2021 to June 30, 2022 — 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, 2023 to present — FQHC encounter rates (updated March 31, 2023)
January 1, 2023 to March 31, 2023 — FQHC encounter rates (updated April 10, 2023))
October 1, 2022 to December 31, 2022 — FQHC encounter rates (updated April 10, 2023)
View all FQHC encounter rates

Enhancement rates

April 1, 2023 to present — FQHC enhancement rates (updated April 24, 2023)
January 1, 2023 to March 31, 2023 — FQHC enhancement rates (published December 21, 2022)
October 1, 2022 to December 31, 2022 — FQHC enhancement rates (updated April 24, 2023)
View all FQHC enhancement rates

Habilitative services

Billing guides

Fee schedules

July 1, 2022 to present — Habilitative services (published June 29, 2022)
July 1, 2021 to June 30, 2022 — Habilitative services (published June 30, 2021)
January 1, 2021 to June 30, 2021 — Habilitative services (updated January 4, 2021)
View all habilitative services fee schedules

Hearing hardware

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

Billing guides

Fee schedules

July 1, 2022 to present — Hearing hardware fee schedule (published June 29, 2022)
April 1, 2022 to June 30, 2022 — Hearing hardware fee schedule (published March 30, 2022)
July 1, 2021 to March 30, 2022 — Hearing hardware fee schedule (published July 8, 2021)
View all hearing hardware fee schedules

Social services (see appropriate fee schedule for rate)

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, 2023 to present — Home health fee schedule (published December 29, 2022)
July 1, 2022 to December 31, 2022 — Home health fee schedule (published June 29, 2022)
January 1, 2022 to June 30, 2022 — Home health fee schedule (updated January 31, 2022)
View all home health services fee schedules

Home infusion therapy/parenteral nutrition

Billing guides

Fee schedules

January 1, 2023 to present — Home infusion therapy/parenteral nutrition fee schedule (updated May 8, 2023)
October 1, 2022 to December 31, 2022 — Home infusion therapy/parenteral nutrition fee schedule (updated May 8, 2023)
July 1, 2022 to September 30, 2022 — Home infusion therapy/parenteral nutrition fee schedule (updated July 14, 2022)
View all home infusion therapy/parenteral nutrition fee schedules

Social services (see appropriate fee schedule for rate)

Hospice

Billing guides

Fee schedules

October 1, 2022 to present — (published September 29, 2022)
October 1, 2021 to September 30, 2022 — Hospice fee schedule (published September 29, 2021)
October 1, 2020 to September 30, 2021 — Hospice fee schedule (published September 21, 2020)
View all hospice 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.

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, 2023 to present — Kidney centers fee schedule (updated April 10, 2023)
January 1, 2023 to March 31, 2023 — Kidney centers fee schedule (published December 20, 2022)
October 1, 2022 to December 31, 2022 — Kidney centers fee schedule (published September 29, 2022)
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

April 1, 2023 to present — Medical Equipment and Supplies fee schedule (updated May 1, 2023)
October 1, 2022 to March 31, 2023 — Medical Equipment and Supplies fee schedule (updated February 7, 2023)
July 1, 2022 to September 30, 2022 — Medical Equipment and Supplies fee schedule (updated July 25, 2022)
View all medical equipment and supplies fee schedules

Social services (see appropriate fee schedule for rate)

Medical nutrition therapy

Billing guides

Fee schedules

July 1, 2022 to present — Medical nutrition therapy fee schedule (updated February 1, 2023)
July 1, 2021 to June 30, 2022 — Medical nutrition therapy fee schedule (published June 30, 2021)
July 1, 2020 to June 30, 2021 — Medical nutrition therapy fee schedule (published July 1, 2020)
View all medical nutrition therapy fee schedules

Social services (see appropriate fee schedule for rate)

Mental health services

Billing guides

Integrated Managed Care (IMC) Service Encounter Reporting

SERI instructions and interim guidance

Fee schedules

Mental health services

April 1, 2023 to present — Mental health and psychology services fee schedule (published March 29, 2023
January 1, 2023 to March 31, 2023 — Mental health and psychology services fee schedule (published December 29, 2022)
July 1, 2022 to December 31, 2022 — Mental health and psychology services fee schedule (published June 29, 2022)
View all mental health services fee schedules

Specialized mental health services

January 1, 2023 to present — Specialized mental health fee schedule (published December 29, 2022)
July 1, 2022 to December 31, 2022 — Specialized mental health fee schedule (updated November 22, 2022)
January 1, 2022 to June 30, 2022 — Specialized mental health fee schedule (published April 4, 2022)
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, 2022 to present — Neurodevelopmental centers fee schedule (published June 29, 2022)
July 1, 2021 to June 30, 2022 — Neurodevelopmental centers fee schedule (published June 30, 2021)
January 1, 2021 to June 30, 2021 — Neurodevelopmental centers fee schedule (updated January 4, 2021)
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, 2023 to present -- OPPS fee schedule (updated June 6, 2023)
January 1, 2023 to March 31, 2023 — OPPS fee schedule (updated March 1, 2023)
October 1, 2022 to December 31, 2022 — OPPS fee schedule (updated December 16, 2022)
July 1, 2022 to September 30, 2022 — OPPS fee schedule (updated October 12, 2022)
April 1, 2022 to June 30, 2022 — OPPS fee schedule (updated June 28, 2022)
January 1, 2022 to March 31, 2022 — OPPS fee schedule (updated October 12, 2022)
October 1, 2021 to December 31, 2021 — OPPS fee schedule (updated June 24, 2022)
View all outpatient fee schedules

Additional information

Outpatient Rehabilitation Program

Billing guides

Fee schedules

July 1, 2022 to present — Outpatient rehabilitation fee schedule (published June 29, 2022)
July 1, 2021 to June 30, 2022 — Outpatient rehabilitation fee schedule (published June 30, 2021)
January 1, 2021 to June 30, 2021 — Outpatient rehabilitation fee schedule (updated January 4, 2021)
View all Outpatient Rehabilitation Program fee schedules

Social services (see appropriate fee schedule for rate)

Pharmacy special services, vaccine administration, and compliance packaging

Fee schedules

July 1, 2022 to present — Pharmacy Special Services fee schedule (published June 29, 2022)
July 1, 2021 to June 30, 2022 — 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)
View all pharmacy special services fee schedules

Physician-related/professional services

Billing guides

Physician-related/professional services fee schedules

April 1, 2023 to present — Physician-related services fee schedule (updated June 6, 2023)
January 1, 2023 to March 31, 2023 — Physician-related services fee schedule (updated May 16, 2023)
October 1, 2022 to December 31, 2022 — Physician-related services fee schedule (updated October 17, 2022)
View all physician-related/professional services fee schedules

Enhanced pediatric fee schedules

January 1, 2023 to present — Enhanced pediatric fee schedule (updated January 3, 2023)
July 1, 2022 to December 31, 2022 — Enhanced pediatric fee schedule (published June 29, 2022)
October 1, 2021 to June 30, 2022 — Enhanced pediatric fee schedule (published September 29, 2021)
View all enhanced pediatric fee schedules

Enhanced adult primary care fee schedules

January 1, 2023 to present — Enhanced adult primary care fee schedule (updated January 3, 2023)
July 1, 2022 to December 31, 2022 — Enhanced adult primary care fee schedule (published June 29, 2022)
October 1, 2021 to June 30, 2022 — Enhanced adult primary care fee schedule (published September 29, 2021)

Medication for Opioid Use Disorder (MOUD) fee schedules

January 1, 2023 to present — Opioid use disorder fee schedule (published December 29, 2022)
July 1, 2022 to December 31, 2022 — Opioid use disorder fee schedule (published June 29, 2022)
July 1, 2021 to June 30, 2022 — Opioid use disorder fee schedule (published June 30, 2021)
View all medication for opioid use disorder fee schedules

Conversion factors

July 1, 2022 to present — Conversion factors (published June 29, 2022)
July 1, 2021 to June 30, 2022 — Conversion factors (published June 30, 2021)
July 1, 2020 to June 30, 2021 — Conversion factors (published June 30, 2020)
View all conversion factors

Additional materials

Planned home births and births in birth centers

Billing guides

Fee schedules

January 1, 2023 to present — Planned home births and births in centers fee schedule (published December 29, 2022)
July 1, 2022 to December 31, 2022 — Planned home births and births in centers fee schedule (published June 29, 2022)
July 1, 2021 to June 30, 2022 — Planned home births and births in centers fee schedule (published June 30, 2021)
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.)

Fee schedules

July 1, 2022 to present — Prenatal diagnosis genetic counseling fee schedule (published June 29, 2022)
July 2021 to June 30, 2022 — Prenatal diagnosis genetic counseling fee schedule (published November 4, 2021)
July 1, 2020 to June 30, 2021 — Prenatal diagnosis genetic counseling fee schedule (published June 30, 2020)
View all prenatal diagnosis genetic counseling fee schedules

Prescription Drug Program

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

Current 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

Billing guides

Fee schedules

January 1, 2023 to present — Private duty nursing fee schedule (published December 29, 2022)
January 1, 2020 to December 31, 2022 — Private duty nursing fee schedule (published December 19, 2019)
July 1, 2016 to December 31, 2019 — Private duty nursing fee schedule (published June 22, 2016)

Social services

Social services supplement (updated October 1, 2020)
View all social services blanket codes

Professional administered drugs

Fee schedules

April 1, 2023 to present — Professional administered drug fee schedule (updated April 26, 2023)
January 1, 2023 to March 31, 2023 — Professional administered drug fee schedule (updated January 18, 2023)
October 1, 2022 to December 31, 2022 — Professional administered drug fee schedule (updated December 5, 2022)
View all professional administered drugs fee schedules

Prosthetics and orthotics

Billing guides

Fee schedules

July 1, 2022 to present — Prosthetic and orthotics fee schedule (updated July 21, 2022)
October 1, 2021 to June 30, 2022 — Prosthetic and orthotics fee schedule (updated November 19, 2021)
July 1, 2021 to September 30, 2021 — Prosthetic and orthotics fee schedule (updated November 19, 2021)
View all prosthetic and orthotics fee schedules

Social services (see appropriate fee schedule for rate)

Respiratory care

Billing guides

Fee schedules

July 1, 2022 to present — Respiratory care fee schedule (updated February 7, 2023)
October 1, 2021 to June 30, 2022 — Respiratory care fee schedule (published September 30, 2021)
July 1, 2021 to September 30, 2021 — Respiratory care fee schedule (published July 8, 2021)
View all respiratory care fee schedules

Social services (see appropriate fee schedule for rate)

Rural health clinics (RHCs)

Billing guides

Encounter rates

April 1, 2023 to present — RHC encounter rates (updated May 2, 2023)
January 1, 2023 to March 31, 2023 — RHC encounter rates (updated January 30, 2023)
October 1, 2022 to December 31, 2022 — RHC encounter rates (updated January 30, 2023)
View all RHC encounter rates

Enhancement rates

April 1, 2023 to present — RHC enhancement rates (updated April 24, 2023)
January 1, 2023 to March 31, 2023 — RHC enhancement rates (published December 21, 2022)
October 1, 2022 to December 31, 2022 — RHC enhancement rates (updated April 24, 2023)
View all RHC enhancement rates

School-based health care services (SBHS)

Billing guides

Fee schedules

July 1, 2022 to present — SBHS fee schedule (published June 29, 2022)
October 1, 2021 to June 30, 2022 — SBHS fee schedule (published November 8, 2021)
July 1, 2021 to September 30, 2021 — SBHS fee schedule (published June 30, 2021)
View all SBHS fee schedules

Sleep centers

Billing guides

Fee schedules

April 1, 2023 to present — Sleep centers fee schedule (published March 29, 2023)
January 1, 2023 to March 31, 2023 — Sleep centers fee schedule (published December 29, 2022)
July 1, 2022 to December 31, 2022 — Sleep centers fee schedule (updated July 25, 2022)
View all sleep centers fee schedules

Centers of Excellence

Sleep study centers directory

Sterilization

Billing guides

Fee schedules

See Physician-related/professional services

Additional materials

Substance Use Disorder Program

Billing guides

April 1, 2023 to present — Substance use disorder billing guide
(Fee-for-service benefits provided outside of the BHO process)
January 1, 2023 to March 31, 2023 — Substance use disorder billing guide
(Fee-for-service benefits provided outside of the BHO process)
October 1, 2022 to December 31, 2022 — Substance use disorder billing guide
(Fee-for-service benefits provided outside of the BHO process)
View all SUD (FFS outside BHO process) billing guides
View all SUD (outpatient) billing guides

Fee schedules

July 1, 2022 to present — Substance use disorder fee schedule (published June 29, 2022)
October 1, 2021 to June 30, 2022 — Substance use disorder fee schedule (published September 30, 2021)
January 1, 2021 to September 30, 2021 — Substance use disorder fee schedule (updated January 21, 2021)
View all substance use disorder fee schedules

Substance-Using Pregnant People (SUPP) Program

Billing Guides

January 1, 2023 to present ― Substance-Using Pregnant People (SUPP) Program billing guide

Fee schedule (reimbursement/rates)

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

Additional information

HCA revenue code grids

Telehealth

Telemedicine policy and billing

Audio-only telemedicine

Physical health audio-only procedure codes

August 1, 2022 to present — Apple Health (Medicaid) physical health audio-only procedure codes (Updated June 16, 2022)

Behavioral health audio-only procedure codes

January 1, 2023 to present - Apple Health (Medicaid) audio-only behavioral health codes (updated February 15, 2023)
August 1, 2022 to December 31, 2022 — Apple Health (Medicaid) audio-only behavioral health codes (updated August 4, 2022)

Telehealth services billing guide audio only supplement

June 28, 2022 to July 31, 2022 — Telehealth services billing guide audio only supplement Refer to Telemedicine policy and billing

COVID-19 public health emergency policies

Clinical policy and billing for COVID-19

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

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

January 1, 2023 to present — TransHealth fee schedule (updated June 6, 2023)

Tribal Health Program

Billing guides

Fee schedules

January 1, 2023 to present — Tribal health program fee schedule (updated March 15, 2023)
January 1, 2022 to December 31, 2022 — Tribal health program fee schedule (published April 13, 2022)
October 1, 2021 to December 31, 2021 — Tribal health program fee schedule (published January 24, 2022)
View all tribal health fee schedules

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: ProfessionalRates@hca.wa.gov

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

Provider billing guides and fee schedules

On this page

Prior authorization (PA)

Claims

Billing guides and fee schedules

Billing guides

Fee schedules

Billing guides

Billing guides

Billing guides

Ambulance transportation

Ground Emergency Medical Transportation (GEMT)

Fee schedules

Additional materials

Billing guides

Fee schedules

Billing guides

Fee schedules

Centers of Excellence

Billing guides

Fee schedules

Billing guides

Fee schedule (reimbursement/rates)

Additional information

Billing guides

Fee schedules

Billing guides

Fee schedules

Billing guides

Fee schedules

Social services (see appropriate fee schedule for rate)

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

Billing guides

Access to Baby and Child Dentistry (ABCD)

Dental-related services

Oral Health Connections (OHC) pilot project

Mobile anesthesia

Fee schedules

Billing guides

Fee schedules

Billing guides

Fee schedules

Other DME

Standard wheelchairs and accessories

Additional materials

Billing guides

Fee schedules

Periodicity schedules

Billing guides

Fee schedules

Billing guides

Family planning fee schedules

SRHP fee schedules

Additional materials

Family planning

Billing guides

Encounter rates

Enhancement rates

Billing guides

Fee schedules

Billing guides

Fee schedules

Social services (see appropriate fee schedule for rate)

Billing guides

Fee schedules

Billing guides

Fee schedules

Billing guides

Fee schedules

Social services (see appropriate fee schedule for rate)

Billing guides

Fee schedules

Billing guides

Billing guides

Fee schedule (reimbursement/rates)

Additional information