Provider billing guides and fee schedules

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)

Billing guides

• January 1, 2020 to present — ABCD billing guide
• August 9, 2019 to December 31, 2019 — ABCD billing guide
• July 1, 2019 to July 31, 2019 — ABCD billing guide
• View all ABCD billing guides

Fee schedules

See Dental Program.

Billing guides

• January 1, 2020 to present — Acute physical medicine and rehabilitation billing guide
• July 1, 2019 to December 31, 2019 — Acute physical medicine and rehabilitation billing guide
• January 1, 2019 to June 30, 2019 — Acute physical medicine and rehabilitation billing guide
• View all acute physical medicine and rehabilitation billing guides

Billing guides

• April 1, 2019 to present — Alien Medical Program billing guide
• July 1, 2018 to March 31, 2019 — Alien Medical Program billing guide
• October 1, 2017 to June 30, 2018 — Alien Medical Program billing guide
• View all Alien Medical Program emergency assistance billing guides

Billing guides

   Ambulance transportation 

• March 1, 2020 to present — Ambulance transportation billing guide
• January 1, 2020 to February 29, 2020 — Ambulance transportation billing guide
• October 1, 2019 to December 31, 2019 — Ambulance and ITA transportation billing guide
• July 1, 2019 to September 30, 2019 — Ambulance and ITA transportation billing guide
• View all ITA transportation billing guides

   Ground Emergency Medical Transportation (GEMT)

• January 1, 2020 to present — Ground Emergency Medical Transportation (GEMT) billing guide
• May 1, 2019 to December 31, 2019 — Ground Emergency Medical Transportation (GEMT) billing guide

Fee schedules

• July 1, 2019 to present — 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

• Treat and refer attestation
• Transportation matrix

Billing guides

• April 1, 2020 to present — ASC billing guide
• February 1, 2020 to March 31, 2020 — ASC billing guide
• January 1, 2020 to January 31, 2020 — ASC billing guide
• July 1, 2019 to December 31, 2019 — ASC billing guide
• View all ASC billing guides

Fee schedules

• July 1, 2018 to present — ASC fee schedule (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
• View all ASC fee schedules

Billing guides

• January 1, 2020 to present —ABA billing guide
• October 1, 2019 to December 31, 2019 —ABA billing guide
• July 1, 2019 to September 30, 2019 — ABA billing guide
• View all ABA billing guides

Fee schedules

• July 1, 2019 to present — ABA fee schedule (published June 24, 2019)
• January 1, 2019 to June 30, 2019 — ABA fee schedule (updated January 22, 2019)
• July 1, 2018 to December 31, 2018 — ABA fee schedule (updated June 29, 2018)
• 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

• July 1, 2019 to present — Blood bank fee schedule (published July 1, 2019)
• January 1, 2019 to June 30, 2019 — Blood bank fee schedule (published December 28, 2018)
• July 1, 2018 to December 31, 2018 — Blood bank fee schedule (published June 26, 2018)
• View all Blood Bank services fee schedules

Billing guides

• July 1, 2019 to present — CUP women program billing guide
• April 1, 2019 to June 30, 2019 — CUP women program billing guide
• July 1, 2018 to March 31, 2019 — 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

• HCA revenue code grids

Billing guides

• April 1, 2019 to present — Childbirth education billing guide
• October 1, 2017 to March 31, 2019 — Childbirth education billing guide
• January 1, 2017 to September 30, 2017 — 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, 2020 to present — Chiropractic services billing guide
• July 1, 2019 to December 31, 2019 — Chiropractic services billing guide
• January 1, 2019 to June 30, 2019 — Chiropractic services billing guide
• View all chiropractic services for children billing guides

Fee schedules

• July 1, 2019 to present — Chiropractic services for children (published June 24, 2019)
• July 1, 2018 to June 30, 2019 — Chiropractic services for children (published June 26, 2018)
• July 1, 2017 to June 30, 2018 — Chiropractic services for children(published June 29, 2017)
• View all chiropractic services for children fee schedules

Billing guides

• January 1, 2020 - present — CRT products and services billing guide
• July 1, 2019 to December 31, 2019 — CRT products and services billing guide
• January 1, 2019 to June 30, 2019 — CRT products and services billing guide
• View all CRT billing guides

Fee schedules

• January 1, 2020 to present — CRT fee schedule (published December 31, 2019)
• January 1, 2019 to December 31, 2019 — CRT fee schedule (updated December 3, 2019)
• July 1, 2018 to December 31, 2018 — CRT fee schedule (published July 2, 2018)
• View all CRT fee schedules

Social Services

• Social services supplement (updated January 1, 2020)
• January 1, 2020 to present — Social services blanket codes
• View all social services blanket codes

Fee schedules

• January 1, 2020 to present - COVID-19 fee schedule (updated March 20, 2020)

Billing guides

Access to Baby and Child Dentistry (ABCD)

See Access to Baby and Child Dentistry (ABCD).

Dental-related services

• April 1, 2020 to present — Dental-related services program billing guide
• January 1, 2020 to March 31, 2020 — Dental-related services program billing guide
• October 1, 2019 to December 31, 2019 — Dental-related services program billing guide
• July 1, 2019 to September 30, 2019 — Dental-related services program billing guide
• View all dental services billing guides

Oral Health Connections (OHC) pilot project

• July 1, 2019 to present — Oral Health Connections pilot project billing guide
• January 1, 2019 - June 30, 2019 — Oral Health Connections pilot project billing guide

Fee schedules

• January 1, 2020 to present — Dental program fee schedule (updated February 10, 2020)
• October 1, 2019 to December 31, 2019 — Dental program fee schedule (published September 30, 2019)
• July 1, 2019 to September 30, 2019 — Dental program fee schedule (updated July 1, 2019)
• View all dental services fee schedules

Billing guides

• January 1, 2020 to present — Diabetes education program billing guide
• July 1, 2019 to December 31, 2019 — Diabetes education program billing guide
• January 1, 2018 to June 30, 2019 — Diabetes education program billing guide
• View all Diabetes Education Program billing guides

Fee schedules

• July 1, to present — Diabetes education (published June 24, 2019)
• July 1, 2018 to June 30, 2019 — Diabetes education (published June 26, 2018)
• July 1, 2017 to June 30, 2018 — Diabetes education (published June 29, 2017)
• View all Diabetes Education Program fee schedules

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

Other DME

• January 1, 2019 to present — Other DME fee schedule (updated December 3, 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 (updated December 3, 2019)
• 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

• View all DME social services blanket codes

Billing guides

• April 1, 2020 to present — EPSDT program billing guide
• January 1, 2020 to March 31, 2020 — EPSDT program billing guide
• October 1, 2019 to December 31, 2019 — EPSDT program billing guide
• July 1, 2019 to September 30, 2019 — EPSDT program billing guide
• View all EPSDT billing guides

Fee schedules

• January 1, 2020 to present — EPSDT fee schedule (published December 31, 2019)
• July 1, 2019 to December 31, 2019 — EPSDT fee schedule (published June 24, 2019)
• January 1, 2019 to June 30, 2019 — EPSDT fee schedule (published December 28, 2018)
• View all EPSDT fee schedules

Billing guides

• April 1, 2020 to present — Enteral nutrition billing guide
• January 1, 2020 to March 31, 2020 — Enteral nutrition billing guide
• July 1, 2019 to December 31, 2019 — Enteral nutrition billing guide
• April 1, 2019 to June 30, 2019 — Enteral nutrition billing guide
• View all enteral nutrition billing guides

Fee schedules

• January 1, 2019 to present — Enteral nutrition fee schedule (published November 6, 2019)
• October 1, 2018 to December 31, 2018 — Enteral nutrition fee schedule (published October 2, 2018)
• July 1, 2015 to September 30, 2018 — Enteral nutrition fee schedule (published June 23, 2015)
• View all enteral nutrition fee schedules

Billing guides

• January 1, 2020 to present — Family planning billing guide
• October 1, 2019 to December 31, 2019 — Family planning billing guide
• August 16, 2019 to September 30, 2019 — Family planning billing guide
• View all family planning billing guides

Fee schedules

• April 1, 2020 to present — Family planning fee schedule (published March 26, 2020)
• January 1, 2020 to March 31, 2020 — Family planning fee schedule (published December 31, 2019)
• July 1, 2019 to December 31, 2019 — Family planning fee schedule (updated August 19, 2019)
• 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

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)

Billing guides

• January 1, 2020 to present — FQHC billing guide
• October 1, 2019 to December 31, 2019 — FQHC billing guide
• July 1, 2019 to September 30, 2019 — FQHC billing guide
• View all FQHC billing guides

Encounter rates

• April 1, 2020 to present — FQHC encounter rates (updated March 26, 2020)
• January 1, 2020 to March 31, 2020 — FQHC encounter rates (updated March 26, 2020)
• October 1, 2019 to December 31, 2019 — FQHC encounter rates (updated March 25, 2020)
• View all encounter rates

Enhancement rates

• January 1, 2020 to present — FQHC enhancement rates (updated February 19, 2020)
• October 1, 2019 to December 31, 2019 — FQHC enhancement rates (updated February 19, 2020)
• July 1, 2019 to September 30, 2019 — FQHC enhancement rates (updated February 19, 2020)
• View all enhancement rates

Billing guides

• January 1, 2020 to present — Habilitative services program billing guide
• October 1, 2019 to December 31, 2019 — Habilitative services program billing guide
• July 1, 2019 to September 30, 2019 — Habilitative services program billing guide
• View all habilitative services billing guides

Fee schedules

• April 1, 2020 to present — Habilitative services (published March 26, 2020)
• January 1, 2020 to March 31, 2020 — Habilitative services (published December 31, 2019)
• July 1, 2019 to December 31, 2019 — Habilitative services (published June 24, 2019)
• View all habilitative services fee schedules

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

Billing guides

• January 1, 2020 to present — Hearing hardware billing guide
• November 1, 2019 to December 31, 2019 — Hearing hardware billing guide
• January 1, 2019 to October 31, 2019 — 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

Social Services

• Social services supplement (updated January 1, 2020)
• January 1, 2020 to present — Social services blanket codes
• View all social services blanket codes

Billing guides

• January 1, 2020 to present — HIV/AIDS case management billing guide
• July 1, 2019 to December 31, 2019 — HIV/AIDS case management billing guide
• January 1, 2019 to June 30, 2019 — 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)
• View all HIV/AIDS program fee schedule

Billing guides

• April 1, 2020 to present — Home health (acute care services) billing guide
• January 1, 2020 to March 31, 2020 — Home health (acute care services) billing guide
• July 1, 2019 to December 31, 2019 — Home health (acute care services) billing guide
• April 1, 2019 to June 30, 2019 — Home health (acute care services) billing guide
• View all home health services billing guides

Fee schedules

• July 1, 2019 to present — Home health fee schedule (published July 1, 2019)
• July 1, 2018 to June 30, 2019 — Home health fee schedule (published June 29, 2018)
• April 1, 2018 to June 30, 2018 — Home health fee schedule (published April 2, 2018)
• View all home health services fee schedules

Billing guides

• January 1, 2020 to present — Home Infusion therapy billing guide
• July 1, 2019 to December 31, 2019 — Home Infusion therapy billing guide
• February 1, 2019 to June 30, 2019 — Home Infusion therapy billing guide
• View all home infusion therapy and nutrition billing guides

Fee schedules

• January 1, 2020 to present — Home infusion therapy/parenteral nutrition fee schedule (published December 31, 2019)
• April 1, 2019 to December 31, 2019 — Home infusion therapy/parenteral nutrition fee schedule (updated December 3, 2019)
• January 1, 2019 to March 31, 2019 — Home infusion therapy/parenteral nutrition fee schedule (updated December 3, 2019)
• View all home infusion therapy/parenteral nutrition fee schedules

Social Services

• Social services supplement (updated January 1, 2020)
• January 1, 2020 to present — Social services blanket codes
• View all social services blanket codes

Billing guides

• January 1, 2020 to present — Hospice services billing guide
• October 1, 2019 to December 31, 2019  — Hospice services billing guide
• July 1, 2019 to September 30, 2019 — Hospice services billing guide
• View all hospice billing guides

Fee schedules

• October 1, 2019 to present — Hospice fee schedule (published September 30, 2019)
• October 1, 2018 to September 30, 2019 — Hospice fee schedule (published September 24, 2018)
• October 1, 2017 to September 30, 2018 — Hospice fee schedule (published October 2, 2017)
• View all hospice fee schedules

Billing guides

• January 1, 2020 to present — Hospital-based inpatient detoxification billing guide
• July 1, 2019 to December 31, 2019 — Hospital-based inpatient detoxification billing guide
• January 1, 2019 to June 30, 2019 — Hospital-based inpatient detoxification billing guide
• View all hospital-based inpatient detoxification billing guides

Billing guides

• February 1, 2020 to present — Inpatient hospital services billing guide
• January 1, 2020 to January 31, 2020 — Inpatient hospital services billing guide
• October 1, 2019 to December 31, 2019 — 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

• HCA revenue code grids
• Guidance for billing MCOs for services provided to newborns
• RAC Eligibility Codes for Healthy Options - Blind/Disabled (HOBD) Clients

Billing guides

• January 1, 2020 to present — Kidney center services billing guide
• July 1, 2019 to December 31, 2019 — Kidney center services billing guide
• January  1, 2019 to June 30, 2019 — Kidney center services billing guide
• View all kidney center services billing guides

Fee schedules

• April 1, 2020 to present — Kidney centers fee schedule (published March 26, 2020)
• January 1, 2020 to March 31, 2020 — Kidney centers fee schedule (published December 30, 2019)
• October 1, 2019 to December 31, 2019 — Kidney centers fee schedule (published September 19, 2019)
• View all kidney center services fee schedules

Billing guides

• January 1, 2020 to present — Long-term care program billing guide
• October 1, 2019 to December 31, 2019 — Long-term care program billing guide
• July 1, 2019 to September 30, 2019 — Long- term acute care program billing guide
• View all long-term acute care billing guides

Billing guides

• January 1, 2020 to present - MSS/ICM billing guide
• October 1, 2019 to December 31, 2019 — MSS/ICM billing guide
• April 1, 2019 to September 30, 2019 — MSS/ICM billing guide
• View all MSS/ICM billing guides

Fee schedules

• January 1, 2020 to present — MSS/ICM fee schedule (published January 9, 2020)
• October 1, 2015 to December 31, 2019 — MSS/ICM fee schedule (published October 7, 2015)
• July 1, 2015 to September 30, 2015 — MSS/ICM fee schedule (published June 15, 2015)
• View all MSS/ICM fee schedules

Billing guides

• January 1, 2020 to present — Medical Equipment and Supplies Billing Guide
• October 1, 2019 to December 31, 2019 — Medical Equipment and Supplies Billing Guide
• August 1, 2019 to September 30, 2019 — Medical Equipment and Supplies Billing Guide
• View all Medical equipment and supplies billing guides

Fee schedules

• January 1, 2020 to present — Medical Equipment and Supplies fee schedule (updated January 13, 2020)
• October 1, 2019 to December 31, 2019 — Medical Equipment and Supplies fee schedule (published October 23, 2019)
• August 1, 2019 to September 30, 2019 — Medical Equipment and Supplies fee schedule (published October 23, 2019)
• View all medical equipment and supplies fee schedules

Social Services

• Social services supplement (updated January 1, 2020)
• January 1, 2020 to present — Social services blanket codes
• View all social services blanket codes

Billing guides

• January 1, 2020 to present — Medical nutrition therapy billing guide
• July 1, 2019 to December 31, 2019 — Medical nutrition therapy billing guide
• January 1, 2019 to June 30, 2019 — Medical nutrition therapy billing guide
• View all medical nutrition therapy billing guides

Fee schedules

• July 1, 2019 to present — Medical nutrition therapy (published June 24, 2019)
• July 1, 2018 to June 30, 2019 — Medical nutrition therapy  (published June 26, 2018)
• July 1, 2017 to June 30, 2018 — Medical nutrition therapy (published June 29, 2017)
• View all medical nutrition therapy fee schedules

Social Services

• Social services supplement (updated January 1, 2020)
• January 1, 2020 to present — Social services blanket codes
• View all social services blanket codes

Billing guides

• January 1, 2020 to present — Mental health services billing guide
• October 1, 2019 to December 31, 2019 — Mental health services billing guide
• July 1, 2019 to September 30, 2019 — Mental health services billing guide
• View all mental health services billing guides

Integrated Managed Care (IMC) Service Encounter Reporting

• SERI instructions and interim guidance

Fee schedules

Mental health services

• January 1, 2020 to present — Mental health and psychology services (updated January 27, 2020)
• July 1, 2019 to December 31, 2019 — Mental health and psychology services (published June 24, 2019)
• April 1, 2019 to June 30, 2019 — Mental health and psychology services (published March 28, 2019)
• View all mental health services fee schedules

Specialized mental health services

• July 1, 2019 to present — Specialized mental health (published June 24, 2019)
• January 1, 2019 to June 30, 2019 — Specialized mental health (published December 28, 2018)
• July 1, 2018 to December 31, 2018 — Specialized mental health (published June 29, 2018)
• View all specialized mental health services fee schedules

Additional materials

• How do providers identify the correct payer?

Billing guides

• April 1, 2020 to present — Neurodevelopmental centers billing guide
• January 1, 2020 to March 31, 2020 — Neurodevelopmental centers billing guide
• July 1, 2019 to December 31, 2019 — Neurodevelopmental centers billing guide
• January 1, 2019 to June 30, 2019 — Neurodevelopmental centers billing guide
• View all neurodevelopmental centers billing guides

Fee schedules

• April 1, 2020 to present — Neurodevelopmental centers fee schedule (published March 26, 2020)
• January 1, 2020 to March 31, 2020 — Neurodevelopmental centers fee schedule (updated February 6, 2020)
• July 1, 2019 to December 31, 2019 — Neurodevelopmental centers fee schedule (updated February 6, 2020)
• View all neurodevelopmental centers fee schedules

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 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

• April 1, 2020 to present — Nursing facilities billing guide
• January  1, 2020 to March 31, 2020 — Nursing facilities billing guide
• July 1, 2019 to December 31, 2019 — Nursing facilities billing guide
• May 15, 2019 to June 30, 2019 — Nursing facilities billing guide
• View all nursing facilities billing guides

Billing guides

• February 8, 2020 to present — Orthodontic service billing guide
• January 1, 2020 to February 7, 2020 — Orthodontic service billing guide
• October 1, 2019 to December 31, 2019 — Orthodontic service billing guide
• August 1, 2019 to September 30, 2019 — Orthodontic service billing guide
• View all orthodontic services billing guides

Fee schedules

See Dental Program.

Billing guides

• April 1, 2020 to present — Outpatient hospital services billing guide
• February 1, 2020 to March 31, 2020 — Outpatient hospital services billing guide
• January 1, 2020 to January 31, 2020 — Outpatient hospital services billing guide
• November 1, 2019 to December 31, 2019 — Outpatient hospital services billing guide
• View all outpatient billing guides

Fee schedules

• January 1, 2020 to present — OPPS fee schedule (updated January 21, 2020)
• October 1, 2019 to December 31, 2019 — OPPS fee schedule (updated November 6, 2019)
• July 1, 2019 to September 30, 2019 — OPPS fee schedule (updated August 21, 2019)
• View all outpatient fee schedules

Additional information

• HCA revenue code grids
• Guidance for billing MCOs for services provided to newborns

Billing guides

• April 1, 2020 to present — Outpatient rehabilitation billing guide
• January 1, 2020 to March 31, 2020 — Outpatient rehabilitation billing guide
• July 1, 2019 to December 31, 2019 — Outpatient rehabilitation billing guide
• January 1, 2019  to June 30, 2019  — Outpatient rehabilitation billing guide
• View all Outpatient Rehabilitation Program billing guides

Fee schedules

• April 1, 2020 to present — Outpatient rehabilitation fee schedule (published March 26, 2020)
• January 1, 2020 to March 31, 2020 — Outpatient rehabilitation fee schedule (published December 31, 2019)
• July 1, 2019 to December 31, 2019 — Outpatient rehabilitation fee schedule (published June 24, 2019)
• View all Outpatient Rehabilitation Program fee schedules

Social Services 

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

Fee schedules

• July 1, 2019 to present — Pharmacy Special Services fee schedule (published June 21, 2019)
• July 1, 2018 to June 30, 2019 — 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)
• View all pharmacy special services fee schedules

Billing guides

• April 1, 2020 to present — Physician-related services/health care billing guide
• February  1, 2020 to March 31, 2020 — Physician-related services/health care billing guide
• January 1, 2020 to January 31, 2020 — Physician-related services/health care billing guide
• November 1, 2019 to December 31, 2019  — Physician-related services/health care billing guide
• View all physician-related/professional services billing guides

Physician-related/professional services fee schedules

• April 1, 2020 to present — Physician-related services fee schedule (published March 26, 2020)
• January 1, 2020 to March 31, 2020 — Physician-related services fee schedule (updated March 12, 2020)
• October 1, 2019 to December 31, 2019 — Physician-related services fee schedule (updated November 1, 2019)
• View all physician-related/professional services fee schedules

Enhanced pediatric fee schedules

• January 1, 2020 to present — Enhanced pediatric fee schedule (published December 31, 2019)
• July 1, 2019 to December 31, 2019 — Enhanced pediatric fee schedule (updated August 22, 2019)
• October 1, 2018 to June 30, 2019 — Enhanced pediatric fee schedule (updated October 1, 2018)

Medication for Opioid Use Disorder fee schedules

• July 1, 2019 to present — Opioid Use Disorder fee schedule (published June 24, 2019)
• October 1, 2018 to June 30, 2019 — Opioid Use Disorder fee schedule (published September 18, 2018)

Conversion factors

• July 1, 2019 to present — Conversion factors (published June 24, 2019)
• July 1, 2018 to June 30, 2019 — Conversion factors (published June 29, 2018)
• July 1, 2017 to June 30, 2018 — Conversion factors (published June 29, 2017)
• View all conversion factors

Additional materials

• Hysterectomy Form [13-365]
• Sterilization Supplemental Billing Guide
• Family Planning Billing Guide
• Guidance for billing MCOs for services provided to newborns

Billing guides

• January  1, 2020 to present — Planned home births and births in centers billing guide
• October 1, 2019 to December 31, 2019 — Planned home births and births in centers billing guide
• July 1, 2019 to September 30, 2019 — Planned home births and births in centers billing guide
• View all planned home births billing guides

Fee schedules

• October 25, 2019 to present — Planned home births and births in centers fee schedule (published November 4, 2019)
• July 1, 2019 to October 24, 2019 — Planned home births and births in centers fee schedule (published November 4, 2019)
• July 1, 2018 to June 30, 2019 — Planned home births and births in centers fee schedule (published June 29, 2018)
• 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.)

• View all Prenatal genetic counseling  billing guides

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)
• View all prenatal diagnosis genetic counseling fee schedules

Billing guides

• January 1, 2020 to present — Prescription drug program billing guide
• October 1, 2019 to December 31, 2019 — Prescription drug program billing guide
• July 1, 2019 to September 30, 2019 — Prescription drug program billing guide
• View all billing guides

Apple Health (Medicaid) expedited authorization (EA) lists

• January 1, 2020 to present — Expedited authorization codes and criteria table
• November 1, 2019 to December 31, 2019 — Expedited authorization codes and criteria table
• July 1, 2018 to October 31, 2019 — 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 effective 1/1/2020
• Apple Health PDL 10/1/2019 - 12/31/2019
• Apple Health PDL 7/1/2019 - 9/30/2019
• Apple Health PDL 04/01/2019 - 06/30/2019
• Apple Health PDL 01/01/2019 - 3/31/2019
• Apple Health PDL 10/1/2018 - 12/31/2018
• Apple Health PDL 7/1/2018 – 9/30/2018

Fee-for-service (FFS) 

• April 1, 2019 to present — Fee-for-service preferred drug list
• January 1, 2019 to March 31, 2019 — 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

• 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.

Billing guides

• January 1, 2020 to present — Private duty nursing for children billing guide
• January 1, 2019 to December 31, 2019 — Private duty nursing for children billing guide
• September 1, 2018 to December 31, 2018 — Private duty nursing for children billing guide
• View all private duty nursing for children billing guides

Fee schedules

• January 1, 2020 to present — 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)
• July 1, 2007 to June 30, 2016 — Private duty nursing fee schedule (updated June 23, 2010)

Social Services

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

Fee schedules

• April 1, 2020 to present — Professional administered drug fee schedule (published March 26, 2020)
• January 1, 2020 to March 31, 2020 — Professional administered drug fee schedule (updated February 19, 2020)
• October 1, 2019 to December 31, 2019 — Professional administered drug fee schedule (updated October 3, 2019)
• View all professional administered drugs fee schedules

Billing guides

• January 1, 2020 to present — Prosthetic and orthotic devices billing guide
• July 1, 2019 to December 31, 2019 — Prosthetic and orthotic devices billing guide
• April 1, 2019 to July 30, 2019 — Prosthetic and orthotic devices billing guide
• View all prosthetic and orthotics billing guides

Fee schedules

• January 1, 2020 to present — Prosthetic and orthotics fee schedule (published December 31, 2019)
• April 1, 2019 to December 31, 2019 — Prosthetic and orthotics fee schedule (updated April 23, 2019)
• July 1, 2018 to March 31, 2019 — Prosthetic and orthotics fee schedule (published June 29, 2018)
• View all prosthetic and orthotics fee schedules

Social Services

• Social services supplement (updated January 1, 2020)
• January 1, 2020 to present — Social services blanket codes
• View all social services blanket codes

Billing guides

• April 1, 2020 to present — Respiratory care billing guide
• January 1, 2020 to March 31, 2020 — Respiratory care billing guide
• October 1, 2019 to December 31, 2019 — Respiratory care billing guide
• July 1, 2019 to September 30, 2019 — Respiratory care billing guide
• View all respiratory care billing guides

Fee schedules

• January 1, 2020 to present — Respiratory care fee schedule (published January 6, 2020)
• July 1, 2019 to December 31, 2019 — Respiratory care fee schedule (published October 23, 2019)
• April 1, 2019 to June 30, 2019 — Respiratory care fee schedule (published April 1, 2019)
• View all respiratory care fee schedules

Social Services

• Social services supplement (updated January 1, 2020)
• January 1, 2020 to present — Social services blanket codes
• View all social services blanket codes

Billing guides

• January 1, 2020 to present — Rural health clinics billing guide
• July 1, 2019 to December 31, 2019 — Rural health clinics billing guide
• April 1, 2019 to June 30, 2019 — Rural health clinics billing guide
• View all RHC billing guides

Encounter rates

• January 1, 2020 to present — Encounter rates (updated March 26, 2020)
• October 1, 2019 to December 31, 2019 — Encounter rates (updated March 25, 2020)
• July 1, 2019 to September 30, 2019 — Encounter rates (updated February 25, 2020)
• View all encounter rates

Enhancement rates

• January 1, 2020 to present — RHC enhancement rates (updated February 19, 2020)
• October 1, 2019 to December 31, 2019 — RHC enhancement rates (updated February 19, 2019)
• July 1, 2019 to September 30, 2019 — RHC enhancement rates (updated February 19, 2019)
• View all enhancement rates

Billing guides

• January 1, 2020 to present — SBHS billing guide
• January 1, 2019 to December 31, 2019 — SBHS billing guide
• January 1, 2018 to December 31, 2018 — SBHS billing guide
• View all SBHS billing guides

Fee schedules

• January 1, 2020 to present — SBHS fee schedule (published December 31, 2019)
• July 1, 2019 to December 31, 2019 — SBHS fee schedule (published June 24, 2019)
• January 1, 2019 to June 30, 2019 — SBHS fee schedule (published December 28, 2018)
• View all SBHS fee schedules

Billing Guides

• January 1, 2020 to present — Sleep centers billing guide
• October 1, 2019 to December 31, 2019 — Sleep centers billing guide
• February 20, 2019 to September 30, 2019 — Sleep centers billing guide

Fee schedules

• January 1, 2020 to present — Sleep centers fee schedule (published January 15, 2020)
• July 1, 2019 to December 31, 2019 — Sleep centers fee schedule (published July 1, 2019)
• January 1, 2019 to June 30, 2019 — Sleep centers fee schedule (published December 28, 2018)
• View all sleep centers fee schedule

Billing guides

• April 1, 2020 to present — Sterilization supplemental billing guide
• January 1, 2020 to March 31, 2020 — Sterilization supplemental billing guide
• August 14, 2019 to December 31, 2019 — Sterilization supplemental billing guide
• July 1, 2019 to August 13, 2019 — Sterilization supplemental billing guide
• View all sterilization billing guides

Fee schedules

See Physician-related/professional services

Additional materials

• Family Planning Billing Guide
• Physician-related/Professional Services Billing Guide
• Sterilization Consent Form (HHS-687) (English)
• Sterilization Consent Form (HHS-687-1) (Spanish)

Billing guides

• January 1, 2020 to present — Substance use disorder billing guide
  (Fee-for-service benefits provided outside of the BHO process)
• October 1, 2019 to December 31, 2019 — Substance use disorder billing guide
  (Fee-for-service benefits provided outside of the BHO process)
• August 1, 2019 to September 30, 2019 — 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

• January 1, 2020 to present — Substance use disorder fee schedule (updated January 8, 2020)

• July 1, 2019 to December 31, 2019 — Substance use disorder fee schedule (updated October 3, 2019)

• August 1, 2018 to June 30, 2019 — Substance use disorder fee schedule (published August 1, 2018)

• View all substance use disorder fee schedules

Fiscal program requirements

• Fiscal program requirements for SUD

Billing guides

• April 1, 2020 to present — Tribal health billing guide
• January 1, 2020 to March 31, 2020 — Tribal health billing guide
• July 1, 2019 to December 31, 2019 — Tribal health billing guide
• April 1, 2019 to June 30, 2019  — Tribal health billing guide
• View all Tribal Health Program billing guides

Fee schedules

• April 1, 2020 to present — Tribal health program fee schedule (published March 26, 2020)
• January 1, 2020 to March 31, 2020 — Tribal health program fee schedule (published January 13, 2020)
• January 1, 2019 to December 31, 2019 — Tribal health program fee schedule (published February 21, 2019)
• View all tribal health fee schedules

Billing guides

• April 1, 2020 to present — Vision hardware billing guide
• January 1, 2020 to March 31, 2020 — Vision hardware billing guide
• July 1, 2019 to December 31, 2019 — Vision hardware billing guide
• April 1, 2019 to June 30, 2019  — 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.