Fee Schedules

Effective July 1, 2009.

This site contains the policies, payment methods, billing codes, and maximum fees used to pay health care and vocational providers who treat injured workers.

Make sure to check the Updates & Corrections tab for any changes to the Fee schedules. Read about the highlights of changes in the last year. These changes are also included in the payment policies.

Quick Reference to frequently used codes (F245-387-000) (40 KB PDF)

Professional and Facility Services Fee Schedules (July 2009)
Item		Excel
Professional Services Fee Schedule - Excel spreadsheet of the complete fee schedule excluding the ASC Fees, AP-DRGs, Hospital Rates and Residential Facility Rates.		5,231 KB
Item	PDF
Anesthesia - CPT ™ 00100 - 01999	141 KB
Evaluation and Management - CPT ™ 99201 - 99499	180 KB
Surgery - CPT ™ 10021 - 69990	1,592 KB
Radiology - CPT ™ 70010 - 79999	777 KB
Pathology and Laboratory - CPT ™ 80047 - 89356	504 KB
Medicine - CPT ™ 90281 - 99607	541 KB
CPT ™ Category II and III - CPT ™ 0001F - 0192T	262 KB
HCPCS - HCPCS A0021 - V5364	1,788 KB
Hospital Only Codes - C1300 - S0093	239 KB
Local Codes by Code - 0401A - 5093V, R0310 - R0392, & V0028	121 KB
Local Codes by Specialty - 0401A - 5093V, R0310 - R0392, & V0028	204 KB
ASC Fee Schedules - All approved codes	442 KB
AP-DRG Assignment - Version 23	112 KB
Hospital Rates	100 KB
Residential Facility Rates	58 KB

Fee Schedules - Comma delimited version		Field Key
Complete fee schedule excluding the ASC Fees, AP-DRGs, Hospital Rates and Residential Facility Rates.	1,512 KB	10 KB
Anesthesia	7 KB	7 KB
Ambulatory Surgery Center	177 KB	66 KB
AP-DRG	48 KB	38 KB
Hospital	13 KB	41 KB

Billing & Payment Policies

Effective July 1, 2009

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

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

Payment Policies
Payment Policies - Complete
Introduction to MARFS Payment Policies (263 KB PDF)
Professional Services Section - Complete (1,028 KB PDF / 2.5 min)
General Information (99 KB PDF) Washington RBRVS Payment System and Policies (104 KB PDF) Evaluation and Management Services (E/M) (206 KB PDF) Surgery Services (206 KB PDF) Anesthesia Services (143 KB PDF) Radiology Services (129 KB PDF) Physical Medicine Services (220 KB PDF) Chiropractic Services (133 KB PDF) Psychiatric Services (134 KB PDF) Other Medicine Services (226 KB PDF)	Naturopathic Physicians (94 KB PDF) Pathology and Laboratory Services (153 KB PDF) Pharmacy (156 KB PDF) Durable Medical Equipment (164 KB PDF) Dental Services (131 KB PDF) Home Health Services (107 KB PDF) Supplies, Materials and Bundled Services (119 KB PDF) Ambulance Services (97 KB PDF) Audiology (164 KB PDF) Interpretive Services (149 KB PDF) Other Services (164 KB PDF) Vocational Services (184 KB PDF)
Facility Services - Complete (486 KB PDF / 1.5 min)
Hospital Payment Policies (146 KB PDF) Ambulatory Surgery Center Payment Policies (124 KB PDF) Brain Injury Rehabilitation Services (103 KB PDF) Nursing Home, Residential and Hospice Care Services (112 KB PDF) Chronic Pain Management Program (112 KB PDF)
Appendices - Complete (650 KB PDF / 1.5 min)
Appendix A: Endoscopy Families (16 KB PDF) Appendix B: Bundled Services (17 KB PDF) Appendix C: Bundled Supplies (87 KB PDF) Appendix D: Non-Covered Codes and Modifiers (322 KB PDF) Appendix E: Modifiers that Affect Payment (128 KB PDF) Appendix F: Outpatient Drug Formulary (305 KB PDF) Appendix G: Documentation Requirements (61 KB PDF)
Index (226 KB PDF)

Highlights of Changes

This Medical Aid Rules and Fee Schedules (fee schedule) is effective for services provided on or after July 1, 2009. These highlights are intended for general reference; they are not a comprehensive list of all the changes in the fee schedule. Refer to the 2009 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 not applied to RBRVS and anesthesia services or to most local codes.
• WAC 296-20-135 maintains the RBRVS conversion factor at $61.53 and the anesthesia conversion factor at $3.19 per minute ($47.85 per 15 minutes).
• WAC 296-23-220 and WAC 296-23-230 maintains 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

• Added a new section addressing Failure to Attend Scheduled Appointment.

Professional Services

• Policies on teleconsultations and telehealth services have been clarified.
• Added a section on radiology reporting requirements.
• The TENS section has been rewritten to include information for self-insurers.
• A clarification was made to Interpretive Services that mileage is payable for missed or no show appointments for IMEs only.
• The Medical Testimony and Depositions section was revised and the payment tables updated.
• L8699 is bundled for professionals when service is performed in a facility.
• A4305 and A4306 can no longer be billed with a 1S modifier.

Facility Services

• Fees including Hospital AP-DRG and Per Diem rates, Residential facilities and, Brain Injury Programs have been updated.
• Lumbar fusions and total knee arthroplasties were removed from the ASC procedure list.

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 are integrated into the fee schedules.
• Durable medical equipment fees have been updated.
• Prosthetics and Orthotics fees have been updated.
• Laboratory fees have been updated.
• Hospital AP-DRG outlier thresholds have been updated.
• 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 fees have been updated.
• Ambulatory surgery center (ASC) fees have been updated.
• Brain injury program fees have been updated.

Updates & Corrections

On this page view:

• Updates to payment policies or fee schedules.
• Corrections to payment policies or fee schedules.

Updates

Payment policy updates

Payment policy updates
Posting date	Description
May 4, 2010	Independent Medical Examinations – This modifies the billing rules for codes 1129M, 1132M and 1133M and adds three new billing codes for multiple claims. Changes are effective April 1, 2010
October 26, 2009	The Psychiatric Payment Policies were updated to include services payable to psychiatric ARNPs. Psychiatric Payment Policies
September 30, 2009	Effective November 1, 2009 the department's Chronic Pain Management Policy will be updated. Please see Provider Bulletin 09-07 for details.
September 21, 2009	Effective July 31, 2009, psychiatric ARNPs may treat injured workers.”
September 15, 2009	As of September 26, 2009, the department will continue to use the Average Wholesale Price provided by First DataBank® for prescription drug pricing.
August 25, 2009	Physicians final report for medical only claims.  Establishes the Physicians Final report as an option for medical only claims.
July 21, 2009	Impairment Rating Exam and Report by Attending Provider - This clarifies who may perform impairment ratings and when the ratings require prior authorization.
Get Help Downloading Files (files open in a new window).

Fee schedules updates

Fee schedule updates
Posting date	Description	Updated version
March 22, 2010	New HCPCS codes effective 4/1/2010	New HCPCS Codes
March 3, 2010	Effective 1/1/2010, the state mileage rate is $0.50 per mile	None.
January 11, 2010	The following orthotic codes require licensure but do not contain a Y in the licensure column of the fee schedule.	Orthotic Codes updates
December 8, 2009	ASC fee schedule code additions that will be effective 01/01/2010.	ASC Codes Additions for 2010
December 8, 2009	ASC fee schedule code deletions that will be effective 12/31/09.	Deleted ASC Codes for 2010
December 7, 2009	CPT® and HCPCS codes invalid after 12/31/2009.	Deleted CPT® and HCPCS Codes for 2010
December 7, 2009	Comma Delimited File of Additional CPT® and HCPCS codes effective 1/1/2010.	January 2010 Updates (Comma Delimited file)
December 7, 2009	Additional CPT® and HCPCS codes effective 1/1/2010.	January 2010 Updates
October 15, 2009	Chronic Pain Management SIMP Follow up codes 2014M and 2015M must be billed by the minute.  Please click on the link to the PDF Billing Codes Instructions document for more details.	Billing Codes Instructions (SIMP follow up codes)
September 15, 2009	Additional HCPCS codes effective October 1, 2009	October 2009 Updates
August 25, 2009	Physicians final report for medical only claims.  Payment code, amount ($25) and effective date.	1026M Fee Schedule Update
July 6, 2009	The following procedures will not be covered by Labor and Industries in Ambulatory Surgery Center facilites effective August 15, 2009.	August 2009 Updates
June 29, 2009	Additional CPT® and HCPCS codes effective 7/1/2009.	July 2009 Updates
June 16, 2009	Fee's for the following CPT ® codes are being updated based on RVU changes from CMS. CPT ® code Non-Facility Fee Facility Fee 93555 $195.67 $195.67 93555-26 $76.30 $76.30 93555-TC $119.37 $119.37 93556 $272.58 $272.58 93556-26 $78.14 $78.14 93556-TC $195.05 $195.05	None.
Get Help Downloading Files (files open in a new window).

Corrections

Payment policies corrections

Payment policy corrections
Posting date	Page(s)	Description
		None at this time...
Get Help Downloading Files (files open in a new window).

Fee schedule corrections

Fee schedules corrections
Posting date	Description	Updated version
January 12, 2010	Codes G0339 and G0340 are not covered in ASC facilities.	None
July 6, 2009	The maximum fee for Plan Implementation Referral Cap, per referral was incorrectly listed in the Vocational Services section of the 2009 Labor and Industries Payment Policies.  The correct maximum fee is: Description Applicable Codes Maximum Fee Plan implementation Referral Cap, per referral 0840V, 0841V $6,818.00	None.
June 30, 2009	ASC Fee Schedule corrections for codes NOT covered.	July 2009 ASC Fee Schedule corrections
June 22, 2009	Some fees were incorrectly listed in the July 1, 2009 fee schedule. Listed below are the corrections. HCPCS Code Non-Facility Setting Facility Setting J1675 $3.26 $3.26 R0075-UN $82.43 $82.43 R0075-UP $54.95 $54.95 R0075-UQ $41.21 $41.21 R0075-UR $32.97 $32.97	None.
June 19, 2009	The following CPT ® codes 70554, 70555, 70557, 70558, and 70559 were inadvertently listed as covered in the fee schedule. These procedures are NOT Covered.	None.
June 16, 2009	CPT® code 88380 was inadvertently listed as By Report in the fee schedule. This code is Not Covered.	None.