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.
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
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.
