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)
  or
• 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

This Medical Aid Rules and Fee Schedules (fee schedule) is effective for services provided on or after July 1, 2008. These highlights are intended for general reference; they are not a comprehensive list of all changes in the fee schedule. Refer to the 2008 CPT™ and HCPCS coding books for complete code descriptions and lists of new, deleted or revised codes.

Washington Administrative Code (WAC) and payment changes

• Cost of living adjustments were applied to RBRVS and anesthesia services and to most local codes.

• WAC 296-20-135 increased the RBRVS conversion factor from $56.38 to $61.53 and increased the anesthesia conversion factor from $3.08 per minute ($46.20 per 15 minutes) to $3.19 per minute ($47.85 per 15 minutes).

• WAC 296-23-220 and WAC 296-23-230 increased the maximum daily cap for physical and occupational therapy services to $118.07.

• WAC 296-23–250 set a daily cap for massage therapy services of 75% of the daily cap for PT/OT services . The rate for July will be $88.55.

Policy & fee schedule additions, changes and clarifications

Introduction

• 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.

Professional Services

• Coding for team conferences, telephone calls and online communications has been completely revised but L&I is not following AMA guidelines for the use of the codes.
• A new example has been added to the Endoscopy section to clarify payment when a surgical procedure has the highest fee.
• Clarifications were made to the chiropractic IME payment policies.
• Psychiatric treatment guidelines contained in the Office of the Medical Director’s Treatment Guidelines were removed from the fee schedule.
• A new Dental payment policy section has been added to MARFS.
• The Home Health Services section has been revised and new codes have been added.
• The Audiology section contains a new policy for the replacement of linear analog hearing aids.
• Non-injectable medication policy was changed showing that miscellaneous oral medication dispensed from the physician’s office is bundled.

Facility Services

• Hospital AP-DRGs have been changed to version 23 from version 21.
• Ambulatory Surgery Center payment method has been completely revised.
• 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

• Preferred Drug List has been updated.
• Other appendices have been updated with new codes.

Fee Schedules

• With the exception of the comma delimited files, the Field Keys have been integrated into the fee schedules.
• Professional fees have been updated.
• Hospital AP-DRG outlier thresholds have been updated with the new AP-DRG version.
• Ambulatory Surgery Center fees have been completely changed.
• Hospital percent of allowed charge (POAC) factors have been updated.
• Hospital rates have been updated.
• Hospital ambulatory payment classification (APC) rates have been updated.
• Residential fee schedule has been updated.