School-based health care services (SBHS)

An updated SBHS billing guide is now available.

What is the School-Based Health Care Services (SBHS) program?

The SBHS program is an optional Medicaid program that provides reimbursement to public school districts, educational service districts, charter, and tribal schools for certain early intervention health-related services or special education health-related services.

These services are reimbursable when a student has Title XIX Medicaid (CNP/MNP) coverage and the services are included in the student's current Individualized Education Program (IEP) or Individualized Family Service Plan (IFSP).

Covered services

The SBHS program reimburses for evaluations, reevaluations. and direct health related services which are included in an eligible student's IEP or IFSP, including:

  • Audiology services
  • Mental health services (individual and group counseling)
  • Nursing services
  • Occupational therapy services
  • Physical therapy services
  • Speech-language therapy services

Provider eligibility

In order to receive Medicaid payment for IEP/IFSP health-related services through the SBHS program, the services must be prescribed or recommended by Department of Health (DOH) licensed providers and must be delivered by or under the direction of DOH licensed providers. A list of SBHS eligible providers can be found in the SBHS billing guide and in WAC 182-537-0350.

SBHS funding structure

The SBHS program is funded with federal and state funds and services are paid on a fee-for-service basis per the SBHS fee schedule.

  • For services provided prior to July 1, 2022, SBHS was funded with 56.2% federal funds, 26.28% school district (local matching funds), and 17.52% state funds.
  • For services provided July 1, 2022-May 10, 2023, SBHS was funded with 56.2% federal funds and 43.8% state funds.
  • For services provided on or after May 11, 2023, SBHS is funded with 50% federal funds and 50% state funds.

How can I participate?

Additional information

Resources for SBHS coordinators and providers

SBHS coordinators
Service providers

SBHS billing information and fee schedule

Trainings and webinars

Additional resources

SBHS billing guide

SBHS 101 training - video | pdf

Apply for a National Provider Identifier (NPI)

SBHS fee schedule

Billing for audiology services - video | pdf

NPI registry


Billing for mental health services - video | pdf

Department of Health


Billing for nursing services - video | pdf



Billing for occupational therapy services - video | pdf



Billing for physical therapy services - video | pdf



Billing for speech-language therapy services - video | pdf


Program updates

SBHS sends updates via our email communications tool, GovDelivery. Sign up for SBHS email notifications. Recent bulletins are linked below, and older bulletins are available upon request.