Fee Schedules
Effective July 1, 2010.
This site contains the policies, payment methods, billing codes, and maximum fees used to pay health care and vocational providers who treat injured workers.
Return to Quick Fee Lookup
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.
2010 Quick Reference Fee Schedule
| Professional and Facility Services Fee Schedules (July 2010) | |||||
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| Item | Excel  |
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| 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 |
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| 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 | ||||
| Medical and Surgical Supplies Codes - HCPCS A4206-A9999 (For DME Providers) |
158 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 |
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| 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 Sept. 1, 2010
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 |  3,747 KB DOC / 13 min |
2,087 KB PDF / 3 min |
| Introduction to MARFS Payment Policies (263 KB PDF) |
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| Professional Services Section - Complete (1,028 KB PDF / 2.5 min) |
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| Facility Services - Complete (486 KB PDF / 1.5 min) |
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| Appendices - Complete (650 KB PDF / 1.5 min) |
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| Index (226 KB PDF) |
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Highlights of Changes
This Medical Aid Rules and Fee Schedules (fee schedule) is effective for services provided on or after July 1, 2010. 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 reduces the RBRVS conversion factor to $60.78 while the anesthesia conversion factor remains at $3.19 per minute ($47.85 per 15 minutes).
- WAC 296-23-220 and WAC 296-23-230 maintain the maximum daily cap for physical and occupational therapy services at $118.07
- WAC 296 -23 –250 set a daily cap for massage therapy of 75% of the daily cap for PT/OT services. The rate for July will remain $88.55.
Policy & fee schedule additions, changes and clarifications
Introduction
- Added a new section addressing Documentation Requirements when Referring Worker Outside of Local Community for Care.
Professional Services
- Created links to all references to Washington Administrative Codes.
- Revised and expanded the section on radiology reporting requirements.
- TENS section has been updated to reflect that these are not covered items.
- Electrodiagnostic services section has been expanded.
- Pharmacy services section reflects a new fee schedule for generic drugs.
- Psychiatric services section has been updated to reflect the addition of psychiatric nurse practitioners as providers.
- Independent Medical Exam section includes new codes for multiple claim exams.
- Interpretive services section reflects new per minute rates for interpreters.
Facility Services
- Fees including Hospital AP-DRG and Per Diem rates, Residential facilities and, Brain Injury Programs have been updated.
- Pain program procedures have been completely revised.
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.
- A new fee schedule for medical and surgical supplies has been established for suppliers who routinely bill for these items. Items listed in the Professional Fee Schedule as bundled will remain bundled for other providers.
- The following fee schedules have been updated:
- Professional fees.
- Durable medical equipment fees.
- Prosthetics and Orthotics fees.
- Laboratory fees.
- Pharmacy fees.
- Dental fees.
- Interpreter fees.
- Hospital AP-DRG outlier thresholds.
- Hospital percent of allowed charge (POAC) factors.
- Hospital rates.
- Hospital ambulatory payment classification (APC) rates.
- Residential fees.
- Ambulatory surgery center (ASC) fees.
Unless noted, all policies in the Medical Aid Rules and Fee Schedules apply to claimants receiving benefits from either the State Fund, the Crime Victims Compensation Program or Self-Insurers.
Providers must follow the administrative rules, medical coverage decisions and payment policies applicable to L&I. You can find this information in the Medical Aid Rules and Fee Schedules, Provider Bulletins and Provider Updates.
Updates & Corrections
On this page view:
- Updates to payment policies or fee schedules.
- Corrections to payment policies or fee schedules.
Updates
| Payment policy updates | |
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| Posting date | Description |
| May 17, 2011 | Effective July 1, 2011, Critical Access Hospitals using swing beds for residential care services can be paid utilizing a hospital-specific Percent Of Allowed Charges (POAC) rate. You may contact an Occupational Nurse Consultant (ONC) for approval. To obtain information about contacting a nurse consultant call the L&I provider hotline at 800-831-5227. Upon approval from an ONC, Critical Access Hospitals should bill their usual and customary charges for sub acute care (swing bed use) on the UB-04 billing form. Identify these services in the Type of Bill field (Form Locator 04) with 018x series (Hospital Swing beds). Does this policy apply to self-insured employers? |
| February 28, 2011 |
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| December 2, 2010 | A new payment policy for drug screening will go into effect on January 1, 2011. |
| September 1, 2010 | Telephone Interpretive Services:
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| Fee schedule updates | ||||||||||||||
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| Posting date | Description |
Updated version |
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| March 8, 2011 | Additional HCPCS codes effective April 1, 2011 | Additional HCPCS Codes Effective April 1, 2011 |
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| January 27, 2011 | The following codes were incorrectly priced in the January 2011 fee schedule update. The correct fees are:
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N/A | ||||||||||||
| January 19, 2011 | Effective January 1, 2011 the rate for POV mileage increased to $0.51 | N/A | ||||||||||||
| December 8, 2010 | ASC Code additions effective January 1, 2011. | ASC Additional Codes Effective January 1, 2011 |
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| December 8, 2010 | ASC Code deletions effective December 31, 2010. | ASC Deleted Codes Effective December 31, 2010 |
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| December 7, 2010 | Additional CPT® and HCPCS codes effective January 1, 2011. | Additional Codes Effective January 1, 2011 |
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| December 7, 2010 | Comma Delimited File of Additional CPT® and HCPCS codes effective January 1, 2011. | Additional Codes Effective January 1, 2011 |
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| December 7, 2010 | CPT® and HCPCS codes invalid after December 31, 2010. | Deleted Codes Effective December 31, 2010 |
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| October 26, 2010 | L8699 is a bundled supply. The department inadvertently left the code as “By Report” in the July 2010 fee schedule. | N/A | ||||||||||||
| October 13, 2010 | The listed procedures will be covered by Labor and Industries in Ambulatory Surgery Center facilities effective October 13, 2010. | Procedure Codes added to ASC Fee Schedule |
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| September 29, 2010 | Effective October 1, 2010 the department is revising the Resource Utilization Group (RUG) payment methodology. RUGs are used to set payment rates for Nursing Homes, Transitional Care Units and Critical Access Hospital swing beds. The change is necessary to keep up with federal revisions to the RUG system enacted by the Centers for Medicare and Medicaid Services (CMS). No new billing codes have been introduced and no billing codes have been deleted. The payment rates for the billing codes are unchanged. |
October 2010 RUG IV Groupings |
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| September 27, 2010 | Effective November 1, 2010, the department or self-insurer will not pay for brand name drugs with generic equivalents unless the prescriber designates Dispense as Written on the prescription. See revised payment table. | Prescription Payment Policy Change |
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| September 9, 2010 | Additional HCPCS codes effective October 1, 2010 | HCPCS codes |
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| June 30, 2010 | CMS has changed the descriptions for 2 HCPCS codes effective 7/1/10. Here are the codes, the new descriptions and coverage. G0428 – Collagen Meniscus Implant, Not Covered G0429 - Dermal filler inject for LDS, Not Covered |
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| June 30, 2010 | Additional CPT and HCPCS codes effective July 1, 2010. | New CPT and HCPCS Codes |
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Corrections
| Payment policy corrections | ||
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| Posting date | Page(s) | Description |
None at this time... |
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| Fee schedules corrections | ||
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| Posting date | Description |
Updated version |
| September 17, 2010 | J0735, Injection, clonidine hydrochloride was mispriced in the July 2010 fee schedule. |
N/A |
