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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.
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:
- 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
Billing guides
- January 1, 2019 to present — Acute physical medicine and rehabilitation billing guide
- April 1, 2018 to December 31, 2018 — Acute physical medicine and rehabilitation billing guide
- January 1, 2018 to March 31, 2018 — Acute physical medicine and rehabilitation billing guide
- View all acute physical medicine and rehabilitation billing guides
Billing guides
- January 1, 2019 to present — Ambulance and ITA transportation billing guide
- April 1, 2018 to December 31, 2018 — Ambulance and ITA transportation billing guide
- January 1, 2018 to March 31, 2018 — Ambulance and ITA transportation billing guide
- View all ITA transportation billing guides
Fee schedules
- January 1, 2006 to present — Ambulance transportation (updated October 4, 2016)
Additional materials
Billing guides
- January 1, 2019 to present — ASC billing guide
- April 1, 2018 to December 31, 2018 — ASC billing guide
- January 1, 2018 to March 31, 2018 — ASC billing guide
- View all ASC billing guides
Fee schedules
- July 1, 2018- present (updated August 16,2018)
- April 1, 2018 to June 30, 2018 — ASC fee schedule (updated May 3, 2018)
- January 1, 2018 to March 31, 2018 — ASC fee schedule
- October 1, 2017 to December 31, 2017 — ASC fee schedule
- View all ASC fee schedules
Billing guides
- January 1, 2019 to present — ABA billing guide
- July 3, 2018 to December 31, 2018 — ABA billing guide
- January 1, 2018 to July 2, 2018 — ABA billing guide
- View all ABA billing guides
Fee schedules
- January 1, 2019 to present — ABA fee schedule (updated January 22, 2019)
- July 1, 2018 to December 31, 2018 — ABA fee schedule (updated June 29, 2018)
- July 1, 2017 to June 30, 2018 — ABA fee schedule (published June 29, 2017)
- View all ABA fee schedules
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
- January 1, 2019 to present — Blood bank fee schedule (published December 28, 2018)
- July 1, 2018 to December 31, 2018 — Blood bank fee schedule (published June 26, 2018)
- July 1, 2017 to June 30, 2018 — Blood bank fee schedule (published June 29, 2017)
- View all Blood Bank services fee schedules
Billing guides
- July 1, 2018 to present — CUP women program billing guide
- January 1, 2017 - June 30, 2018 — CUP women program billing guide
- October 1, 2016 - December 31, 2016 — CUP women program billing guide
- View all CUP billing guides
Fee schedule (reimbursement/rates)
See Inpatient Prospective Payment System (IPPS) on the Hospital reimbursement page.
Additional information
Billing guides
- October 1, 2017 to present — Childbirth education billing guide
- January 1, 2017 to September 30, 2017 — Childbirth education billing guide
- October 1, 2016 to December 31, 2016 — Childbirth education billing guide
- View all childbirth education billing guides
Fee schedules
- January 1, 2007 to present — Childbirth education (Updated June 23, 2010)
Billing guides
- January 1, 2019 to present — Chiropractic services billing guide
- January 1, 2018 to December 31, 2018 — Chiropractic services billing guide
- October 1, 2017 to December 31, 2017 — Chiropractic services billing guide
- View all chiropractic services for children billing guides
Fee schedules
- July 1, 2018 to present — Chiropractic services for children (Published June 26, 2018)
- July 1, 2017 to June 30, 2018 — Chiropractic services for children(Published June 29, 2017)
- July 1, 2016 to June 30, 2017 — Chiropractic services for children (Published June 28, 2016)
- View all chiropractic services for children fee schedules
Billing guides
- January 1, 2019 to present — CRT products and services billing guide
- July 1, 2018 to December 31, 2018 — CRT products and services billing guide
- January 1, 2018 to June 30, 2018 — CRT products and services billing guide
- View all CRT billing guides
Fee schedules
- January 1, 2019 to present — CRT fee schedule (published December 31, 2018)
- July 1, 2018 to December 31, 2018 — CRT fee schedule (published July 2, 2018)
- April 1, 2018 to June 30, 2018 — CRT fee schedule (updated April 12, 2018)
- View all CRT fee schedules
Additional materials
Billing guides
Access to Baby and Child Dentistry (ABCD)
See Access to Baby and Child Dentistry (ABCD).
Dental-related services
- January 1, 2019 to present — Dental-related services program billing guide
- October 1, 2018 to December 31, 2018 — Dental-related services program billing guide
- July 1, 2018 to September 30, 2018 — Dental-related services program billing guide
- View all dental services billing guides
Oral Health Connections (OHC) pilot project
Fee schedules
- January 1, 2019 to present — Dental program fee schedule (published December 28, 2018)
- October 1, 2018 to December 31, 2018 — Dental program fee schedule (updated October 15, 2018)
- July 1, 2018 to September 30, 2018 — Dental program fee schedule (updated July 2, 2018)
- View all dental services fee schedules
Billing guides
- January 1, 2018 to present — Diabetes education program billing guide
- October 1, 2017 to December 31, 2017 — Diabetes education program billing guide
- July 1, 2017 to September 30, 2017 — Diabetes education program billing guide
- View all Diabetes Education Program billing guides
Fee schedules
- July 1, 2018 to present — Diabetes education (Published June 26, 2018)
- July 1, 2017 to June 30, 2018 — Diabetes education (Published June 29, 2017)
- July 1, 2016 to June 30, 2017 — Diabetes education (Published June 28, 2016)
- View all Diabetes Education Program fee schedules
Billing guides
- January 1, 2019 to present — 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
Other DME
- January 1, 2019 to present — Other DME fee schedule (updated February 12, 2019)
- July 1, 2018 to December 31, 2018 — Other DME fee schedule (published July 2, 2018)
- April 1, 2018 to June 30, 2018 — Other DME fee schedule (published April 6, 2018)
- View all Other DME fee schedules
Standard wheelchairs and accessories
- January 1, 2019 to present — Wheelchairs and accessories fee schedule (published December 31, 2018)
- July 1, 2018 to December 31, 2018 — Wheelchairs and accessories fee schedule (updated November 6, 2018)
- January 1, 2018 to June 30, 2018 — Wheelchairs and accessories fee schedule (published January 3, 2018)
- View all standard wheelchairs fee schedules
Additional materials
Billing guides
- January 1, 2019 to present — EPSDT program billing guide
- October 25, 2018 to December 31, 2018 — EPSDT program billing guide
- October 1, 2018 to October 24, 2018 — EPSDT program billing guide
- View all EPSDT billing guides
Fee schedules
- January 1, 2019 to present — EPSDT fee schedule (published December 28, 2018)
- October 1, 2018 to December 31, 2018 — EPSDT fee schedule (published September 24, 2018)
- July 1, 2018 to September 30, 2018 — EPSDT fee schedule (published June 26, 2018)
- View all EPSDT fee schedules
Billing guides
- January 1, 2019 to present — Enteral nutrition billing guide
- July 1, 2018 to December 31, 2018 — Enteral nutrition billing guide
- January 1, 2018 to June 30, 2018 — Enteral nutrition billing guide
- View all enteral nutrition billing guides
Fee schedules
- October 1, 2018 to present — Enteral nutrition fee schedule (published October 2, 2018)
- July 1, 2015 to September 30, 2018 — Enteral nutrition fee schedule (published June 23, 2015)
- January 1, 2015 to June 30, 2015 — Enteral nutrition fee schedule (updated March 16, 2015)
- View all enteral nutrition fee schedules
Billing guides
- January 1, 2019 to present — Family planning billing guide
- October 1, 2018 to December 31, 2018 — Family planning billing guide
- July 1, 2018 to September 30, 2018 — Family planning billing guide
- View all family planning billing guides
Fee schedules
- January 14, 2019 to present — Family planning fee schedule (published February 4, 2019)
- October 1, 2018 to January 13, 2019 — Family planning fee schedule (published November 28, 2018)
- July 1, 2018 to September 30, 2018 — Family planning fee schedule (updated July 10, 2018)
- View all family planning fee schedules
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
Take Charge
- Take Charge program (family planning non-Medicaid)
- Take Charge provider directory
- Take Charge Client Application (form 13-781)
- Take Charge SSN referral (form 13-823)
Billing guides
- January 1, 2019 to present — FQHC billing guide
- October 1, 2018 to December 31, 2018 — FQHC billing guide
- July 1, 2018 to September 30, 2018 — FQHC billing guide
- View all FQHC billing guides
Encounter rates
- January 1, 2019 to present —FQHC encounter rates (updated March 5, 2019)
- October 1, 2018 to December 31, 2018 — FQHC encounter rates (updated February 28, 2019)
- July 1, 2018 to September 30, 2018 — FQHC encounter rates (updated January 28, 2019)
- View all encounter rates
Enhancement rates
- January 1, 2019 to present — FQHC enhancement rates (published January 3, 2019)
- October 1, 2018 to December 31, 2018 — FQHC enhancement rates (published October 4, 2018)
- July 1, 2018 to September 30, 2018 — FQHC enhancement rates (published June 29, 2018)
- View all enhancement rates
Billing guides
- January 1, 2019 to present — Habilitative services program billing guide
- October 1, 2018 to December 31, 2018 — Habilitative services program billing guide
- January 1, 2018 to September 30, 2018 — Habilitative services program billing guide
- View all habilitative services billing guides
Fee schedules
- July 1, 2018 to present — Habilitative services (Published June 26, 2018)
- January 1, 2018 to June 30, 2018 — Habilitative services (Updated January 19, 2018)
- July 1, 2017 to December 31, 2017 — Habilitative services (Published June 29, 2017)
- View all habilitative services fee schedules
For Apple Health clients and clients of the Developmental Disabilities Administration.
Billing guides
- January 1, 2019 to present — Hearing hardware billing guide
- October 1, 2018 to December 31, 2018 — Hearing hardware billing guide
- January 1, 2018 to September 30, 2018 — Hearing hardware billing guide
- View all hearing hardware billing guides
Fee schedules
- January 1, 2019 to present — Hearing hardware fee schedule (updated February 25, 2019)
- January 1, 2018 to December 31, 2018 — Hearing hardware fee schedule (published December 27, 2017)
- July 1, 2015 to December 31, 2017 — Hearing hardware fee schedule (published June 23, 2015)
- View all hearing hardware fee schedules
Additional materials
- January 1, 2019 (updated) — Social services blanket codes
- August 24, 2018 (updated) — Social services blanket codes
- April 13, 2018 (updated) — Social services blanket codes
- April 28, 2017 (updated) — Social services blanket codes
- January 1, 2017 (updated)— Social services blanket codes
- August 7, 2015 (updated)— Social services blanket codes
Billing guides
- January 1, 2019 to present — HIV/AIDS case management billing guide
- July 1, 2018 to December 31, 2018 — HIV/AIDS case management billing guide
- January 1, 2018 to June 30, 2018 — HIV/AIDS case management billing guide
- View all HIV/AIDS program billing guides
Fee schedules
- July 1, 2018 to present — HIV/AIDS case management (Published June 26, 2018)
- July 1, 2016 to June 30, 2018 — HIV/AIDS case management (Published June 28, 2016)
- April 1, 2016 to June 30, 2016 — HIV/AIDS case management (Published March 25, 2016)
- View all HIV/AIDS program fee schedule
Billing guides
- January 1, 2019 to present — Home health (acute care services) billing guide
- January 1, 2018 to December 31, 2019 — Home health (acute care services) billing guide
- October 1, 2017 to December 31, 2017 — Home health (acute care services) billing guide
- View all home health services billing guides
Fee schedules
- July 1, 2018 to present — Home health (Published June 29, 2018)
- April 1, 2018 to June 30, 2018 — Home health (Published April 2, 2018)
- January 1, 2018 to March 31, 2018 — Home health (Published February 15, 2018)
- View all home health services fee schedules
Billing guides
- February 1, 2019 to present — Home Infusion therapy billing guide
- January 1, 2019 to January 31, 2019 — Home infusion therapy billing guide
- January 1, 2018 to December 31, 2018 — Home infusion therapy billing guide
- October 1, 2017 to December 31, 2017 — Home infusion therapy billing guide
- View all home infusion therapy and nutrition billing guides
Fee schedules
- January 1, 2019 to present — Home infusion therapy/parenteral nutrition fee schedule (published December 31, 2018)
- January 1, 2018 to December 31, 2018 — Home infusion therapy/parenteral nutrition fee schedule (published December 29, 2017)
- July 1, 2017 to December 31, 2017 — Home infusion therapy/parenteral nutrition fee schedule (updated July 31, 2017)
- View all home infusion therapy/parenteral nutrition fee schedules
Additional materials
Billing guides
- January 1, 2019 to present — Hospice services billing guide
- May 1, 2018 to December 31, 2018 — Hospice services billing guide
- October 1, 2017 to April 30, 2018 — Hospice services billing guide
- View all hospice billing guides
Fee schedules
- October 1, 2018 to present — Hospice fee schedule (published September 24, 2018)
- October 1, 2017 to September 30, 2018 — Hospice fee schedule (published October 2, 2017)
- October 1, 2016 to September 30, 2017 — Hospice fee schedule (published September 21, 2016)
- View all hospice fee schedules
Billing guides
- January 1, 2019 to present — Hospital-based inpatient detoxification billing guide
- January 1, 2018 to December 31, 2018 — Hospital-based inpatient detoxification billing guide
- October 1, 2017 to December 31, 2017 — Hospital-based inpatient detoxification billing guide
- July 1, 2017 to September 30, 2017 — Hospital-based inpatient detoxification billing guide
- View all hospital-based inpatient detoxification billing guides
Billing guides
- March 1, 2019 to present — Inpatient hospital services billing guide
- January 1, 2019 to February 28, 2019 — Inpatient hospital services billing guide
- October 1, 2018 to December 31, 2018 — Inpatient hospital services billing guide
- July 1, 2018 to September 30, 2018 — Inpatient hospital services billing guide
- View all inpatient hospital billing guides
Fee schedule (reimbursement/rates)
See Inpatient Prospective Payment System (IPPS) on the Hospital reimbursement page.
Additional information
Billing guides
- January 1, 2019 - present — Kidney center services billing guide
- October 1, 2018 - December 31, 2018 — Kidney center services billing guide
- July 1, 2018 to September 30, 2018 — Kidney center services billing guide
- View all kidney center services billing guides
Fee schedules
- January 1, 2019 to present — Kidney centers fee schedule (updated December 27, 2018)
- October 1, 2018 to December 31, 2018 — Kidney centers fee schedule (updated October 23, 2018)
- July 1, 2018 to September 30, 2018 — Kidney centers fee schedule (updated June 27, 2018)
- View all kidney center services fee schedules
Billing guides
- July 1, 2018 to present — MSS/ICM billing guide
- April 1, 2018 - June 30, 2018 — MSS/ICM billing guide
- January 1, 2018 to March 31, 2018 — MSS/ICM billing guide
- View all MSS/ICM billing guides
Fee schedules
- October 1, 2015 to present — MSS/ICM case management (Published October 7, 2015)
- July 1, 2015 to September 30, 2015 — MSS/ICM case management (Published June 15, 2015)
- View all MSS/ICM fee schedules
Billing guides
- January 1, 2019 to present — Medical nutrition therapy billing guide
- January 1, 2018 to December 31, 2018 — Medical nutrition therapy billing guide
- October 1, 2017 - December 31, 2017 — Medical nutrition therapy billing guide
- July 1, 2017 - September 30, 2017 — Medical nutrition therapy billing guide
- View all medical nutrition therapy billing guides
Fee schedules
- July 1, 2018 to present — Medical nutrition therapy (Published June 26, 2018)
- July 1, 2017 to June 30, 2018 — Medical nutrition therapy (Published June 29, 2017)
- July 1, 2016 to June 30, 2017 — Medical nutrition therapy (Published June 28, 2016)
- View all medical nutrition therapy fee schedules
Additional materials
Billing guides
- January 1, 2019 - present — Mental health services billing guide
- October 11, 2018 - December 31, 2018 — Mental health services billing guide
- October 1, 2018 to October 10, 2018 — Mental health services billing guide
- View all mental health services billing guides
Integrated Managed Care (IMC) Service Encounter Reporting Instructions
Fee schedules
Mental health services
- January 1, 2019 to present — Mental health and psychology services (published December 28, 2018)
- July 1, 2018 to December 31, 2018 — Mental health and psychology services (published June 26, 2018)
- January 1, 2018 to June 30, 2018 — Mental health and psychology services (updated December 29, 2017)
- View all mental health services fee schedules
Specialized mental health services
- January 1, 2019 to present — Specialized mental health (published December 28, 2018)
- July 1, 2018 to December 31, 2018 — Specialized mental health (published June 29, 2018)
- January 1, 2018 to June 30, 2018 — Specialized mental health (published December 27, 2017)
- View all specialized mental health services fee schedules
Billing guides
- January 1, 2019 to present — Neurodevelopmental centers billing guide
- July 1, 2018 to December 31, 2018 — Neurodevelopmental centers billing guide
- January 1, 2017 to June 30, 2018 — Neurodevelopmental centers billing guide
- View all neurodevelopmental centers billing guides
Fee schedules
- January 1, 2019 to present — Neurodevelopmental centers fee schedule (published December 28, 2018)
- July 1, 2018 to December 31, 2018 — Neurodevelopmental centers fee schedule (published June 29, 2018)
- January 1, 2018 to June 30, 2018 — Neurodevelopmental centers fee schedule (updated January 19, 2018)
- View all neurodevelopmental centers fee schedules
Billing guides
- January 1, 2019 to present — Nondurable medical supplies and equipment billing guides
- July 1, 2018 to December 31, 2018 — Nondurable medical supplies and equipment billing guides
- January 1, 2018 to June 30, 2018 — Nondurable medical supplies and equipment billing guides
- View all nondurable medical supplies and equipment billing guides
Fee schedules
- January 1, 2019 to present — Nondurable medical supplies and equipment fee schedule (published January 23, 2019)
- January 1, 2018 to December 31, 2018 — Nondurable medical supplies and equipment fee schedule (published December 29, 2017)
- January 1, 2017 to December 31, 2017 — Nondurable medical supplies and equipment fee schedule (published December 28, 2016)
- View all nondurable medical supplies and equipment fee schedules
Billing guides
- January 1, 2019 - present - Orthodontic services billing guide
- October 1, 2018 - December 31, 2018 — Orthodontic services billing guide
- July 1, 2018 to September 30, 2018 — Orthodontic services billing guide
- View all orthodontic services billing guides
Fee schedules
See Dental Program.
Billing guides
- January 1, 2019 to present — Outpatient hospital services billing guide
- October 1, 2018 to December 31, 2018 — Outpatient hospital services billing guide
- July 1, 2018 to September 30, 2018 — Outpatient hospital services billing guide
- View all outpatient billing guides
Fee schedules
- January 1, 2019 to present — OPPS fee schedule (updated February 19, 2019)
- October 1, 2018 to December 31, 2018 — OPPS fee schedule (updated October 11, 2018)
- July 1, 2018 to September 30, 2018 — OPPS fee schedule (updated December 27, 2018)
- View all outpatient fee schedules
Additional information
Billing guides
- January 1, 2019 to present — Outpatient rehabilitation billing guide
- October 1, 2018 to December 31, 2018 — Outpatient rehabilitation billing guide
- January 1, 2018 to September 30, 2018 — Outpatient rehabilitation billing guide
- View all Outpatient Rehabilitation Program billing guides
Fee schedules
- January 1, 2019 to present — Outpatient rehabilitation fee schedule (published December 28, 2018)
- July 1, 2018 to December 31, 2018 — Outpatient rehabilitation fee schedule (published June 29, 2018)
- January 1, 2018 to June 30, 2018 — Outpatient rehabilitation fee schedule (updated January 19, 2018)
- View all Outpatient Rehabilitation Program fee schedules
Additional materials
Fee schedules
- July 1, 2018 to Present — Pharmacy Special Services fee schedule (updated July 30, 2018)
- January 1, 2018 to June 30, 2018 — Pharmacy Special Services fee schedule (updated March 14, 2018)
- October 1, 2017 to December 31, 2017 — Pharmacy Special Services fee schedule (published March 14, 2018)
- View all pharmacy special services fee schedules
Billing guides
- February 16, 2019 to present —Physician-related services/health care billing guide
- January 1, 2019 to February 15, 2019 — Physician-related services/health care billing guide
- October 16, 2018 to December 31, 2018 — Physician-related services/health care billing guide
- October 1, 2018 to October 15, 2018 — Physician-related services/health care billing guide
- View all physician-related/professional services billing guides
Physician-related/professional services fee schedules
- January 1, 2019 to present — Physician-related services fee schedule (updated February 6, 2019)
- October 1, 2018 to December 31, 2018 — Physician-related services fee schedule (updated October 16, 2018)
- July 1, 2018 to September 30, 2018 — Physician-related services fee schedule (updated July 30, 2018)
- View all physician-related/professional services fee schedules
Enhanced pediatric fee schedules
- October 1, 2018 to present — Enhanced pediatric fee schedule (updated October 1, 2018)
Medication assisted treatment (MAT) fee schedules
- October 1, 2018 to present — MAT fee schedule (published September 18, 2018)
Audiology services fee schedules (Prior to January 1, 2017)
- July 1, 2016 to December 31, 2016 — Audio fee schedule (Updated July 21, 2016)
- April 1, 2016 to June 30, 2016 — Audio fee schedule (Published April 27, 2016)
- View all Audiology Program fee schedules
Conversion factors
- July 1, 2018 to present — Conversion factors (Published June 29, 2018)
- July 1, 2017 to June 30, 2018 — Conversion factors (Published June 29, 2017)
- July 1, 2016 to June 30, 2017 — Conversion factors
- View all conversion factors
Additional materials
Billing guides
- January 1, 2019 to present — Planned home births and births in centers billing guide
- July 1, 2018 to December 31, 2018 — Planned home births and births in centers billing guide
- April 1, 2018 to June 30, 2018 — Planned home births and births in centers billing guide
- View all planned home births billing guides
Fee schedules
- July 1, 2018 to present — Planned home births and births in centers fee schedule (Published June 29, 2018)
- March 1, 2018 to June 30, 2018 — Planned home births and births in centers fee schedule (Published February 15, 2018)
- July 1, 2017 to February 28, 2018 — Planned home births and births in centers fee schedule (Updated July 18, 2017)
- View all planned home births fee schedules
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
- April 1, 2014 to September 30, 2015 — Prenatal genetic counseling provider guide
- March 8, 2013 to March 31, 2014 — Medicaid provider guide prenatal genetic counseling
- July 1, 2011 to March 7, 2013 — Medicaid provider guide prenatal genetic counseling
- May 9, 2010 to June 30, 2011 — Prenatal genetic counseling billing instructions
- January 1, 2007 to May 8, 2010 — Prenatal genetic counseling billing instructions
Fee schedules
- July 1, 2017 to present — Prenatal diagnosis genetic counseling fee schedule (Published June 29, 2017)
- July 1, 2016 to June 30, 2017 — Prenatal diagnosis genetic counseling fee schedule (Published June 28, 2016)
- July 1, 2015 to June 30, 2016 — Prenatal diagnosis genetic counseling fee schedule (Posted March 25, 2016)
- View all prenatal diagnosis genetic counseling fee schedules
Billing guides
- October 1, 2018 to present — Prescription drug program billing guide
- July 1, 2018 to September 30, 2018 — Prescription drug program billing guide
- April 1, 2018 to June 30, 2018 — Prescription drug program billing guide
- View all billing guides
Apple Health (Medicaid) expedited authorization (EA) lists
- July 1, 2018 to present — Expedited authorization codes and criteria table
- February 1, 2018 to June 30, 2018 — Expedited authorization codes and criteria table
- January 1, 2018 to January 31, 2018 — Expedited authorization codes and criteria table
- View all 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
If you can't find the drug you are looking for on the Apple Health PDL, contact the managed care plan. For the FFS plan, see the FFS lists below.
- Apple Health PDL 04/01/2019 pre-release
- Apple Health PDL 01/01/2019 - 3/31/2019
- Apple Health PDL 10/1/2018 - 12/31/2018
Fee-for-service (FFS)
- January 1, 2019 to present - Fee -for-service preferred drug list
- October 1, 2018 to December 31, 2018 — Fee-for-service preferred drug list
- July 1, 2018 to September 30, 2018 — Fee-for-service preferred drug list
- View all FFS PDLs
For previous versions, email us applehealthpharmacypolicy@hca.wa.gov.
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.
For children
Billing guides
- January 1, 2019 to present — Private duty nursing for children billing guide
- September 1, 2018 to December 31, 2018 — Private duty nursing for children billing guide
- July 1, 2018 to August 31, 2018 — Private duty nursing for children billing guide
- View all private duty nursing for children billing guides
Fee schedules
- July 1, 2016 to present — Private duty nursing fee schedule (Published June 22, 2016)
- July 1, 2007 to June 30, 2016 — Private duty nursing fee schedule (Updated June 23, 2010)
Additional materials
For adults
- Social services supplement for adults (Published January 1, 2017)
- Social services supplement for adults (Published January 15, 2015)
Fee schedules
Fee schedules
- January 1, 2019 to present — Professional administered drug fee schedule (updated March 4, 2019)
- October 1, 2018 to December 31, 2018 — Professional administered drug fee schedule (updated October 9, 2018)
- July 1, 2018 to September 30, 2018 — Professional administered drug fee schedule (updated August 29, 2018)
- View all professional administered drugs fee schedules
Fee schedules (prior to July 1, 2016)
- April 1, 2016 to June 30, 2016 — Injectable drug fee schedule (Published March 25, 2016)
- January 1, 2016 to March 31, 2016 — Injectable drug fee schedule (Updated February 12, 2016)
- View all injectables fee schedules
Billing guides
- January 1, 2019 to present — Prosthetic and orthotic devices billing guide
- July 1, 2018 to December 31, 2018 — Prosthetic and orthotic devices billing guide
- April 1, 2018 to June 30, 2018 — Prosthetic and orthotic devices billing guide
- View all prosthetic and orthotics billing guides
Fee schedules
- July 1, 2018 to present — Prosthetic and orthotics fee schedule (Published June 29, 2018)
- April 1, 2018 to June 30, 2018 — Prosthetic and orthotics fee schedule(Published April 2, 2018)
- October 1, 2017 to March 31, 2018 — Prosthetic and orthotics fee schedule (Published September 26, 2017)
- View all prosthetic and orthotics fee schedules
Additional materials
Billing guides
- February 16, 2019 to present — Respiratory care billing guide
- January 1, 2019 to February 15, 2019 — Respiratory care billing guide
- October 1, 2018 to December 31, 2018 — Respiratory care billing guide
- July 1, 2018 to September 30, 2018 — Respiratory care billing guide
- View all respiratory care billing guides
Fee schedules
- January 1, 2019 to present — Respiratory care fee schedule (updated January 7, 2019)
- July 1, 2018 to December 31, 2018 — Respiratory care fee schedule (published June 29, 2018)
- January 1, 2018 to June 30, 2018 — Respiratory care fee schedule (updated January 4, 2018)
- View all respiratory care fee schedules
Additional materials
Billing guides
- January 1, 2019 to present — Rural health clinics billing guide
- October 1, 2018 to December 31, 2018 — Rural health clinics billing guide
- July 1, 2018 to September 30, 2018 — Rural health clinics billing guide
- View all RHC billing guides
Encounter rates
- January 1, 2019 to present — Encounter rates (updated February 27, 2019)
- October 1, 2018 to December 31, 2018 — Encounter rates (updated December 21, 2018)
- July 1, 2018 to September 30, 2018 — Encounter rates (updated August 15, 2018)
- View all encounter rates
Enhancement rates
- January 1, 2019 to present — RHC enhancement rates (published January 3, 2019)
- October 1, 2018 to December 31, 2018 — RHC enhancement rates (published October 4, 2018)
- July 1, 2018 to September 30, 2018 — RHC enhancement rates (published June 29, 2018)
- View all enhancement rates
Billing guides
- January 1, 2019 to present — SBHS billing guide
- January 1, 2018 to December 31, 2018 — SBHS billing guide
- January 1, 2017 to December 31, 2017 — SBHS billing guide
- View all SBHS billing guides
Fee schedules
- January 1, 2019 to present — SBHS fee schedule (published December 28, 2018)
- July 1, 2018 to December 31, 2018 — SBHS fee schedule (updated July 11, 2018)
- January 1, 2018 to June 30, 2018 — SBHS fee schedule (published December 27, 2017)
- View all SBHS fee schedules
Billing Guides
- February 20, 2019 to present — Sleep centers billing guide
- January 1, 2019 to February 19, 2019 — Sleep centers billing guide
- July 1, 2018 to December 31, 2018 — Sleep centers billing guide
Fee schedules
- January 1, 2019 to present — Sleep centers fee schedule (published December 28, 2018)
- July 1, 2018 to December 31, 2018 — Sleep centers fee schedule (published June 25, 2018)
- View all sleep centers fee schedule
Billing guides
- January 1, 2019 to present — Sterilization supplemental billing guide
- January 1, 2018 to December 31, 2018 — Sterilization supplemental billing guide
- October 1, 2017 to December 31, 2017 — Sterilization supplemental billing guide
- July 1, 2017 to September 30, 2017 — Sterilization supplemental billing guide
- View all sterilization billing guides
Fee schedules
See Physician-related/professional services
Additional materials
Billing guides
- January 1, 2019 to present — Substance use disorder billing guide
(Fee-for-service benefits provided outside of the BHO process) - October 1, 2018 to December 31, 2018 — Substance use disorder billing guide
(Fee-for-service benefits provided outside of the BHO process) - August 1, 2018 to September 30, 2018 — Substance use disorder billing guide
(Fee-for-service benefits provided outside of the BHO process) - July 1, 2018 to July 31, 2018 — 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
-
August 1, 2018 to present — Substance use disorder fee schedule (published August 1, 2018)
- July 1, 2018 to July 31, 2018 — Substance use disorder fee schedule (published June 29, 2018)
- July 1, 2017 to June 30, 2018 — Substance use disorder fee schedule (published June 29, 2017)
- View all substance use disorder fee schedules
Billing guides
- January 1, 2019 to present — Tribal health billing guide
- October 1, 2018 to December 31, 2018 — Tribal health billing guide
- April 1, 2018 to September 30, 2018 — Tribal health billing guide
- View all Tribal Health Program billing guides
Fee schedules
- January 1, 2019 to present — Tribal health program fee schedule (published February 21, 2019)
- July 1, 2018 to December 31, 2018 — Tribal health program fee schedule (updated July 18, 2018)
- January 1, 2018 to June 30, 2018 — Tribal health program fee schedule (published December 31, 2017)
- View all tribal health fee schedules
Billing guides
- April 1, 2019 to present — Vision hardware billing guide
- January 1, 2019 to present — Vision hardware billing guide
- July 1, 2018 to December 31, 2018 — Vision hardware billing guide
- January 1, 2018 to June 30, 2018 — Vision hardware billing guide
- View all vision hardware 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: web form
Phone: 1-800-562-3022
