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.

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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.

The following items are found in other guides and no longer listed separately:

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

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

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

Billing guides

Fee schedules

Mental health services
Mental health services (Prior to July 1, 2014)
Specialized mental health services

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

Fee schedules (prior to July 1, 2016)

Billing guides

Fee schedules

Fee schedules (prior to July 1, 2015)

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