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.

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.

Access to baby and child dentistry (ABCD)

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.

Billing guides

Fee schedules

See Dental Program.

Acute physical medicine and rehabilitation

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.

Billing guides

Alien Medical Program emergency assistance

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.

Billing guides

Ambulance transportation

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.

Billing guides

Ambulance transportation
Ground Emergency Medical Transportation (GEMT)

Fee schedules

Additional materials

Ambulatory surgery centers (ASCs)

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.

Billing guides

Fee schedules

Applied behavior analysis (ABA)

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.

Billing guides

Fee schedules

Centers of Excellence

Blood bank services

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.

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

Chemical-Using Pregnant (CUP) Program

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.

Billing guides

Fee schedule (reimbursement/rates)

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

Additional information

Childbirth education

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.

Billing guides

Fee schedules

Chiropractic services for children

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.

Billing guides

Fee schedules

Complex rehabilitation technology (CRT)

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.

Billing guides

Fee schedules

Social services

COVID-19

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.

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

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.

Billing guides

Access to Baby and Child Dentistry (ABCD)

See Access to Baby and Child Dentistry (ABCD).

Dental-related services
Oral Health Connections (OHC) pilot project
Mobile anesthesia

Fee schedules

Diabetes Education Program

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.

Billing guides

Fee schedules

Durable medical equipment (DME)

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.

Billing guides

Fee schedules

Other DME
Standard wheelchairs and accessories

Additional materials

Early and periodic screening, diagnosis and treatment (EPSDT)

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.

Billing guides

Fee schedules

Periodicity schedules

Enteral nutrition

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Billing guides

Fee schedules

Family planning

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.

Billing guides

Family planning fee schedules

SRHP fee schedules

Additional materials

Family planning

Federally qualified health centers (FQHCs)

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.

Billing guides

Encounter rates

Enhancement rates

Habilitative services

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.

Billing guides

Fee schedules

Hearing hardware

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.

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

Billing guides

Fee schedules

Social services

HIV/AIDS case management

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.

Billing guides

Fee schedules

Home health services (acute care services)

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.

Billing guides

Fee schedules

Home infusion therapy/parenteral nutrition

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.

Billing guides

Fee schedules

Social services

Hospice

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.

Billing guides

Fee schedules

Hospital-based inpatient detoxification

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.

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

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.

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

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.

Billing guides

Fee schedules

Long term acute care

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.

Billing guides

Maternity support services/infant case management (MSS/ICM)

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.

Billing guides

Fee schedules

Medical equipment and supplies

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.

Billing guides

Fee schedules

Social services

Medical nutrition therapy

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.

Billing guides

Fee schedules

Social services

Mental health services

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.

Billing guides

Integrated Managed Care (IMC) Service Encounter Reporting

Fee schedules

Mental health services
Specialized mental health services

Additional materials

Neurodevelopmental centers

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.

Billing guides

Fee schedules

Nondurable medical supplies and equipment

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.

Billing guides

Fee schedules

Nursing facilities

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.

Billing guides

Orthodontic services

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.

Billing guides

Fee schedules

See Dental Program.

Outpatient hospital

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.

Billing guides

Fee schedules

Additional information

Outpatient Rehabilitation Program

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.

Billing guides

Fee schedules

Social services

Pharmacy special services, vaccine administration, and compliance packaging

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.

Fee schedules

Physician-related/professional services

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.

Billing guides

Physician-related/professional services fee schedules

Enhanced pediatric fee schedules

Enhanced adult primary care fee schedules

Medication for Opioid Use Disorder (MOUD) fee schedules

Conversion factors

Additional materials

Planned home births and births in birth centers

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.

Billing guides

Fee schedules

Prenatal diagnosis genetic counseling

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.

Billing guides

(Effective October 1, 2015 this guide was merged into the physician-related services/health care professional services billing guide. See Physician-related/professional services.)

Fee schedules

Prescription Drug Program

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.

Billing guides

Apple Health (Medicaid) expedited authorization (EA) lists

For previous versions, email us applehealthpharmacypolicy@hca.wa.gov.

Apple Health (Medicaid) preferred drug lists (PDLs)

Managed care plans and fee-for-service (FFS) plans

All agency-contracted managed care organizations (MCOs) and the fee-for-service (FFS) program use the Apple Health PDL.

The Apple Health PDL can be found on the agency's Apple Health PDL page.

FFS state maximum allowable cost (SMAC) list

To request an FFS change in reimbursement

Download the Pharmacy Information Authorization form (13-835A). Fax the request to: 866-668-1214.

Private duty nursing

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.

Billing guides

Fee schedules

Social services

Professional administered drugs

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Fee schedules

Prosthetics and orthotics

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.

Billing guides

Fee schedules

Social services

Respiratory care

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.

Billing guides

Fee schedules

Social services

Rural health clinics (RHCs)

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.

Billing guides

Encounter rates

Enhancement rates

School-based health care services (SBHS)

 

Billing guides

Fee schedules

Sleep centers

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.

Billing guides

Fee schedules

Centers of Excellence

Sterilization

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.

Billing guides

Fee schedules

See Physician-related/professional services

Additional materials

Substance Use Disorder Program

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.

Billing guides

Fee schedules

Telehealth

Telemedicine policy and billing

Audio-only telemedicine

Physical health audio-only procedure codes
Behavioral health audio-only procedure codes
Telehealth services billing guide audio only supplement

COVID-19 public health emergency policies

Clinical policy and billing for COVID-19
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

 

Tribal Health Program

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.

Billing guides

Fee schedules

Vision hardware for clients 20 years of age and younger

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.

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