On July 7, 2008, CMS published its proposed rule to update the Medicare Physician Fee Schedule (MPFS) for calendar year (CY) 2009. Note: The Agency now reissues the entire billing manual when making updates, rather than just a page or section. Authorization form (HCA 13 -835 ). October 1, 2012 F.2 Billing for Genetic Counseling Add information regarding genetic counselors. A National Provider Identifier (NPI) number is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). There is a convenience fee to apply online. Surcharge fee for Washington Physician Health Program. The DOC Pharmaceutical Management & Formulary Manual governs the prescribing of medication to inmates. After reviewing your application, we may contact you with additional questions. For fee schedule and rate questionsEmail: ProfessionalRates@hca.wa.gov, For all other provider questionsMedical Assistance Customer Service Center (MACSC)Online: web formPhone: 1-800-562-3022, Copyright © 2020 Washington Health Care Authority, Long-term services and supports (LTSS) and hospice, Autism & Applied Behavioral Analysis (ABA) therapy, Medically Intensive Children's Program (MICP), American Indians and Alaska Natives (AI/AN), Apple Health coverage without managed care, Update my income or address (report a change), Pregnant mother finds comfort during uncertain times, Apple Health client inspired to help others access health coverage, Apple Health supported client while searching for job, Telehealth helps a mother connect with her child during pandemic, Foster parent helps kids get overdue medical care through Apple Health, After accident, hiker gets the care she needs through Apple Health, Apple Health worker helps ease financial worries of new mother, Facing high diabetes treatment costs, Apple Health (Medicaid) saves the day, Access to housing, employment, and health care gives Yakima resident a second chance, Cancer patient lives a quality life thanks to Apple Health, New mother and baby have healthy start thanks to Apple Health, Apple Health covers medically necessary surgery when other insurance wouldn’t, Apple Health leads the way to a better life for autism spectrum disorder (ASD) client, Apple Health for Kids provides relief for new parents, Access to health care allows student to pursue education stress-free, Children’s Health Insurance Program (CHIP) keeps health care affordable for families, Helping Apple Health (Medicaid) clients when they need it most, Apple Health gives life to those with chronic disease, Mother and daughter have a better life because of Apple Health, Apple Health provides otherwise unaffordable, life-saving medication for HIV patient, Apple Health outreach staff help spread the word about free and low-cost health insurance, Apple Health and community partners help improve the health of the Latino population in Washington, Apple Health brings stability to lives of young couple, I can’t begin to explain how much Apple Health has helped me, I wouldn’t be able to afford health insurance otherwise, Apple Health gives me a sense of security, Helping people navigate their way to Washington Apple Health, Apple Health has given her such peace of mind, Contact Washington Apple Health (Medicaid), Child and youth behavioral health services, Wraparound with Intensive Services (WISe), Substance use disorder prevention and mental health promotion, Painful life lessons become strengths for crisis counselor, Integrated approach delivers all care “right here, right now”, General eligibility requirements that apply to all Apple Health programs, Modified Adjusted Gross Income (MAGI) based programs manual, Long-term services and supports (LTSS) manual, Uniform Medical Plan (UMP) administered by Regence BlueShield and WSRxS, Health plans with health savings accounts (HSAs), Medical Flexible Spending Arrangement (FSA), Not participating in a Washington State-sponsored retirement plan, Health plans with health savings accounts (HSAs) (non-Medicare), Long-term disability insurance (unpaid leave only), PEBB Continuation Coverage premiums (non-Medicare), PEBB Continuation Coverage premiums (Medicare), Life insurance premiums (unpaid leave only), Long-term disability insurance premiums (unpaid leave only), SEBB Continuation Coverage spousal plan questionnaire 2020, Public Employees Benefits Board (PEBB) Program, Archived agendas, minutes, & presentations, School Employees Benefits Board (SEBB) Program. Contact us for previous fee schedules. Washington Apple Health (Medicaid) Physician-Related Services/Health Care Professional Services . Refer to this section for claims and status information related to services provided while an inmate is in an inpatient or outpatient status in the hospital, or to transport an inmate to and/or from an offsite hospital. A completed Home Health & Hospice Authorization Request Form, HCA 13 -847 , and all the documentation listed on this form and any other medical justification. For Apple Health clients and clients of the Developmental Disabilities Administration. 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. These billing instructions are for offsite professional providers, facilities, and hospitals. Future SPAs will be developed as each update becomes due, and copies may be requested as soon as they are available. January 1, 2021 to present — Neurodevelopmental centers billing guide, October 1, 2020 to December 31, 2020 — Neurodevelopmental centers billing guide, January 1, 2020 to March 31, 2020 — Neurodevelopmental centers billing guide, View all neurodevelopmental centers billing guides, January 1, 2021 to present — Neurodevelopmental centers fee schedule, July 1, 2020 to December 31, 2020 — Neurodevelopmental centers fee schedule, April 1, 2020 to June 30, 2020 — Neurodevelopmental centers fee schedule, View all neurodevelopmental centers fee schedules, Nondurable medical supplies and 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, January 1, 2019 to March 31, 2019 — Nondurable medical supplies and equipment fee schedule, January 1, 2018 to December 31, 2018 — Nondurable medical supplies and equipment fee schedule, January 1, 2017 to December 31, 2017 — Nondurable medical supplies and equipment fee schedule, View all nondurable medical supplies and equipment fee schedules, January 1, 2021 to present — Nursing facilities billing guide, October 1, 2020 to December 31, 2020 — Nursing facilities billing guide, April 1, 2020 to September 30, 2020 — Nursing facilities billing guide, View all nursing facilities billing guides, October 1, 2020 to present — Orthodontic service billing guide, February 8, 2020 to September 30, 2020 — Orthodontic service billing guide, January 1, 2020 to February 7, 2020 — Orthodontic service billing guide, View all orthodontic services billing guides, January 1, 2021 to present — Outpatient hospital services billing guide, October 1, 2020 to December 31, 2020 — Outpatient hospital services billing guide, July 1, 2020 to September 30, 2020 — Outpatient hospital services billing guide, January 1, 2021 present - OPPS fee schedule, July 1, 2020 to September 30, 2020 — OPPS fee schedule, April 1, 2020 to June 30, 2020 — OPPS fee schedule, January 1, 2021 to present — Outpatient rehabilitation billing guide, October 20, 2020 to December 31, 2020 — Outpatient rehabilitation billing guide, October 1, 2020 to October 19, 2020 — Outpatient rehabilitation billing guide, View all Outpatient Rehabilitation Program billing guides, January 1, 2021 to present — Outpatient rehabilitation fee schedule, July 1, 2020 to December 31, 2020 — Outpatient rehabilitation fee schedule, April 1, 2020 to June 30, 2020 — Outpatient rehabilitation fee schedule, View all Outpatient Rehabilitation Program fee schedules, May 22, 2020 to November 16, 2020 - Social services blanket codes, Pharmacy special services, vaccine administration, and compliance packaging, July 1, 2020 to present — Pharmacy Special Services fee schedule, July 1, 2019 to June 30, 2020 — Pharmacy Special Services fee schedule, July 1, 2018 to June 30, 2019 — Pharmacy Special Services fee schedule, View all pharmacy special services fee schedules, January 1, 2021 to present — Physician-related services/health care billing guide, October 1, 2020 to December 31, 2020 — Physician-related services/health care billing guide, September 1, 2020 to September 30, 2020 — Physician-related services/health care billing guide, View all physician-related/professional services billing guides, January 1, 2021 to present — Physician-related services fee schedules, October 1, 2020 to December 31, 2020 — Physician-related services fee schedule, July 1, 2020 to September 30, 2020 — Physician-related services fee schedule, View all physician-related/professional services fee schedules, January 1, 2021 to present — Enhanced pediatric fee schedule, July 1, 2020 to December 31, 2020 — Enhanced pediatric fee schedule, January 1, 2020 to June 30, 2020 — Enhanced pediatric fee schedule, View all enhanced pediatric fee schedules, January 1, 2021 to present — Opioid Use Disorder fee schedule, July 1, 2020 to December 31, 2020 — Opioid Use Disorder fee schedule, July 1, 2019 to June 30, 2020 — Opioid Use Disorder fee schedule, View all medication for opioid use disorder fee schedules, July 1, 2020 to present — Conversion factors, July 1, 2019 to June 30, 2020 — Conversion factors, July 1, 2018 to June 30, 2019 — Conversion factors, Planned home births and births in birth centers, January 1, 2021 to present — Planned home births and births in centers billing guide, October 1, 2020 to December 31, 2020 — Planned home births and births in centers billing guide, July 1, 2020 to September 30, 2020 — Planned home births and births in centers billing guide, View all planned home births billing guides, July 1, 2020 to present — Planned home births and births in centers fee schedule, April 1, 2020 to June 30, 2020 — Planned home births and births in centers fee schedule, October 25, 2019 to March 31, 2020 — Planned home births and births in centers fee schedule, View all planned home births fee schedules, View all Prenatal genetic counseling billing guides, July 1, 2020 to present — Prenatal diagnosis genetic counseling fee schedule, July 1, 2017 to June 30, 2020 — Prenatal diagnosis genetic counseling fee schedule, July 1, 2016 to June 30, 2017 — Prenatal diagnosis genetic counseling fee schedule, View all prenatal diagnosis genetic counseling fee schedules, January 1, 2021 to present - Prescription drug program billing guide, October 1, 2020 to December 31, 2020 - Prescription drug program billing guide, August 6, 2020 to September 30, 2020 - Prescription drug program billing guide, December 1, 2020 to present - Expedited authorization codes and criteria table, July 1, 2020 to November 30, 2020 — Expedited authorization codes and criteria table, January 1, 2020 to June 30, 2020 — Expedited authorization codes and criteria table, November 1, 2019 to December 31, 2019 — Expedited authorization codes and criteria table, October 1, 2020 to present - Private duty nursing for children billing guide, July 17, 2020 to September 30, 2020 - Private duty nursing for children billing guide, January 1, 2020 to July 16, 2020 — Private duty nursing for children billing guide, View all private duty nursing for children billing guides, January 1, 2020 to present — Private duty nursing fee schedule, July 1, 2016 to December 31, 2019 — Private duty nursing fee schedule, July 1, 2007 to June 30, 2016 — Private duty nursing fee schedule, January 1, 2021 to present — Professional administered drug fee schedule, October 1, 2020 to December 31, 2020 — Professional administered drug fee schedule, July 1, 2020 to September 30, 2020 — Professional administered drug fee schedule, View all professional administered drugs fee schedules, January 1, 2021 to present — Prosthetic and orthotic devices billing guide, October 1, 2020 to December 31, 2020 — Prosthetic and orthotic devices billing guide, July 1, 2020 to September 30, 2020 — Prosthetic and orthotic devices billing guide, View all prosthetic and orthotics billing guides, October 1, 2020 to present — Prosthetic and orthotics fee schedule, July 1, 2020 to September 30, 2020 — Prosthetic and orthotics fee schedule, January 1, 2020 to June 30, 2020 — Prosthetic and orthotics fee schedule, View all prosthetic and orthotics fee schedules, May 22, 2020 to November 16, 2020 — Social services blanket codes, October 1, 2020 to present — Respiratory care billing guide, April 1, 2020 to September 30, 2020 — Respiratory care billing guide, January 1, 2020 to March 31, 2020 — Respiratory care billing guide, October 1, 2020 to present — Respiratory care fee schedule, July 1, 2020 to September 30, 2020 — Respiratory care fee schedule, April 1, 2020 to June 30, 2020 — Respiratory care fee schedule, January 1, 2021 to present — Rural health clinics billing guide, October 1, 2020 to December 31, 2020 — Rural health clinics billing guide, July 1, 2020 to September 30, 2020 — Rural health clinics billing guide, January 1, 2021 to present — Encounter rates, October 1, 2020 to December 31, 2020 — Encounter rates, July 1, 2020 to September 30, 2020 — Encounter rates, January 1, 2021 to present — RHC enhancement rates, October 1, 2020 to December 31, 2020 — RHC enhancement rates, July 1, 2020 to September 30, 2020 — RHC enhancement rates, October 1, 2020 to present--SBHS billing guide, August 1, 2020 to September 30, 2020 - SBHS billing guide, January 1, 2020 to July 31, 2020 — SBHS billing guide, July 1, 2020 to present — SBHS fee schedule, January 1, 2020 to June 30, 2020 — SBHS fee schedule, July 1, 2019 to December 31, 2019 — SBHS fee schedule, October 1, 2020 to present — Sleep centers billing guide, January 1, 2020 to September 30, 2020 — Sleep centers billing guide, October 1, 2019 to December 31, 2019 — Sleep centers billing guide, July 1, 2020 to present — Sleep centers fee schedule, January 1, 2020 to June 30, 2020 — Sleep centers fee schedule, July 1, 2019 to December 31, 2019 — Sleep centers fee schedule, January 1, 2021 to present - Sterilization supplemental billing guide, October 1, 2020 to December 31, 2020 — Sterilization supplemental billing guide, July 1, 2020 to September 30, 2020 — Sterilization supplemental billing guide, Physician-related/Professional Services Billing Guide, Sterilization Consent Form (HHS-687) (English), Sterilization Consent Form (HHS-687-1) (Spanish), January 1, 2021 to present — Substance use disorder billing guide, August 1, 2020 to December 31, 2020 — Substance use disorder billing guide, July 1, 2020 to July 31, 2020 — Substance use disorder billing guide, View all SUD (FFS outside BHO process) billing guides, January 1, 2021 to present — Substance use disorder fee schedule, October 1, 2020 to December 31, 2020 — Substance use disorder fee schedule, January 1, 2020 to September 30, 2020 — Substance use disorder fee schedule, View all substance use disorder fee schedules, January 1, 2021 to present — Tribal health billing guide, October 1, 2020 to December 30, 2020 — Tribal health billing guide, April 1, 2020 to September 30, 2020 — Tribal health billing guide, View all Tribal Health Program billing guides, January 1, 2021 to present — Tribal health program fee schedule, April 1, 2020 to December 31, 2020 — Tribal health program fee schedule, January 1, 2020 to March 31, 2020 — Tribal health program fee schedule, Vision hardware for clients 20 years of age and younger, October 1, 2020 to present — Vision hardware billing guide, July 1, 2020 to September 30 2020 — Vision hardware billing guide, April 1, 2020 to June 30, 2020 — Vision hardware billing guide, Guidance for hospitals in billing MCOs for services provided to newborns, Website feedback: Tell us how we’re doing, Children’s mental health services and psychology (see, Interpreter services (no billing guide, see our, Occupational therapy, physical therapy, and speech/audiology (see, (Fee-for-service benefits provided outside of the BHO process). 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