Provider billing guides and fee schedules

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This page contains billing guides, fee schedules, and additional billing materials.

Important note: Billing guides with dates prior to October 1, 2016, will have broken links. If this occurs, please refer to the most recent guide.

Prior authorization (PA) and claims

Use the billing guides and fee schedules to help you:

  • Determine if you need a PA for a given treatment, and
  • Find the information necessary to file and submit a claim.

Do you need a PA form? Visit our Forms and publications webpage to download the General Information for Authorization and/or Pharmacy Information Authorization forms.

Billing guides and fee schedules

Use the following links to jump down the page: 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

Fee schedules

After December 31, 2016, please see Physician-Related/Professional Services.

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

Billing guides

Chemical Dependency (renamed as Substance Use Disorder)

Fee schedules

See Substance Use Disorder Program for dates of service on and after July 1, 2015

Billing guides

Fee schedules

Other DME
Standard wheelchairs and accessories

Additional materials

For Apple Health clients age 20 and younger and DDA clients age 21 and older.

Billing guides

Fee schedules

Additional materials

Fee schedules

For dates of service on and after July 1, 2016, please see Professional Administered Drugs fee schedule.

Billing instructions not available. Under contract.

Fee schedules

See Outpatient Rehabilitation Program for dates of service on and after April 1, 2011.

Fee schedules

See Outpatient Rehabilitation Program for dates of service on and after April 1, 2011.

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

Fee schedules

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
Fee-for-service (FFS) 

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.

Fee schedules

For dates of service before July 1, 2016, please see Injectable Drugs fee schedule.

Fee schedules

See Mental Health Services for dates of services on and after July 1, 2014.

Fee schedules

See Outpatient Rehabilitation Program for dates of service on and after April 1, 2011.
See Audiology Program for dates of service on and after April 1, 2011.

Billing guides

Fee schedules

Contact

For fee schedule and rate questions
 
For all other provider questions
Medical Assistance Customer Service Center (MACSC)
Online: Web form
Phone:1-800-562-3022