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Payment Policies

These payment policies determine under what conditions we will pay health care and vocational providers who treat injured workers and crime victims.

• Payment policies (1,189 KB/3 min PDF)
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• Payment policies (4,894 KB/13 min DOC)

Note: Make sure to check the Updates & Corrections tab for any changes to the Payment policies.

Highlights of Changes in the last year

These highlights are intended for general reference; they are not a comprehensive list of all changes in the fee schedule. Refer to the 2007 CPT™ and HCPCS coding books for complete code descriptions and lists of new, deleted or revised codes.

Washington Administrative Code (WAC) and payment changes

• WAC 296-20-135 increased the RBRVS conversion factor from $54.22 to $56.38. and increased the anesthesia conversion factor from $2.97 per minute ($44.55 per 15 minutes) to $3.08 per minute ($46.20 per 15 minutes).
• WAC 296-23-220 and WAC 296-23-230 increased the maximum daily cap for physical and occupational therapy services to $113.84.

Policy & fee schedule additions, changes and clarifications

Introduction

1. Provider Bulletins have been changed to temporary announcements of policy changes. The most up-to-date information will always reside on the L&I site within their topic area and not just in the bulletins. Bulletins will only be available to download from the L&I site for a maximum of 2 years.
2. Providers may use their National Provider Indentifier (NPI) to bill L&I when the NPI number has been registered with L&I. See L&I's NPI site for more information.
3. Coverage decisions made by the Office of the Medical Director are now listed in MARFS.

Professional Services

1. IME Section was changed to include information on obtaining records from the Claim and Account Center (page 92).
2. E-mail communications with the worker are now payable when personally made by the attending provider, consultant or psychologist (page 35).
3. The insurer, with prior authorization, pays for bone growth stimulators for specific conditions (page 46).
4. The insurer, with prior authorization, covers botulinum toxin injections for specific indications (page 46).
5. The insurer, with prior authorization, pays for epidural adhesiolysis, percutaneous lysis of epidural adhesions, epidural decompressive, neuroplasty and Racz neurolysis when workers meet specific criteria (page 47).
6. L&I use of the Washington State Preferred Drug List (PDL) and how providers may endorse the list has been expanded (page 99).
7. Information on obtaining authorization for non-preferred drugs has been added (page 101).
8. Policy on pharmacy services billed through a third party pharmacy biller have changed (page 102).
9. L&I primarily rents oxygen equipment (page 104).
10. Interpreter mileage documentation needs to support the number of miles between appointments (page 129).
11. Policy on locum tenens has been updated (page 132).

Facility Services

Fees including Hospital AP-DRG and per diem rates, Residential facilities, Brain Injury Programs, Pain Management Programs and Ambulatory Surgery Centers have been updated.

Appendices

1. Preferred Drug List has been updated.
2. Other appendicies have been updated with new codes.
3. Anesthesia services paid by RBRVS has been removed.

Fee Schedules

The following have been updated:

• Professional fees,
• Hospital AP-DRG outlier thresholds,
• Ambulatory Surgery Center codes,
• Hospital percent of allowed charge (POAC) factors,
• Hospital rates,
• Hospital ambulatory payment classification (APC) rates and
• The residential fee schedule has been added.