2017 Fee Schedules
Effective July 1, 2017.
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.
Professional and Facility Services Fee Schedules (July 2017)
- Professional Services Fee Schedule – Excel spreadsheet of the complete fee schedule the ASC Fees, AP-DRGs, Hospital Rates and Residential Facility Rates.
- Anesthesia – CPT™ 00100 - 01999
- Evaluation and Management – CPT™ 99201 - 99499
- Surgery – CPT™ 10021 - 69990
- Radiology – CPT™ 70010 - 79999
- Pathology and Laboratory – CPT™ 80047 - 89356
- Medicine – CPT™ 90281 - 99607
- CPT ™ Category II and III – CPT™ 0001F - 0192T
- HCPCS – HCPCS A0021 - V5364
- Medical and Surgical Supplies Codes – HCPCS A4206-A9999
(For DME Providers)
- Facility Only Codes – C1300 - S0093
- Local Codes by Code – 0401A - 5093V, R0310 - R0392, & V0028
- Local Codes by Specialty – 0401A - 5093V, R0310 - R0392, & V0028
- ASC Fee Schedules – All approved codes
- APR-DRG Assignment – Version 31
- Hospital Rates
- Residential Facility Rates
Fee Schedules - Comma delimited version with Field Key
2017 Billing & Payment Policies
Effective July 1, 2017
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 Complete (2017)
- Chapter 3 - Ambulance Services
- Chapter 4 - Anesthesia Services
- Chapter 5 - Audiology and Hearing Services
- Chapter 6 - Biofeedback, Electrocardiograms (EKG), Electrodiagnostic services, and Extracorporeal shockwave therapy (ESWT)
- Chapter 7 - Chiropractic Services
- Chapter 8 - Dental Services
- Chapter 9 - Durable Medical Equipment (DME)
- Chapter 10 - Evaluation and Management (E/M) Services
- Chapter 11 - Home Health Services
- Chapter 12 - Impairment Rating Services
- Chapter 13 - Independent Medical Exams (IME)
- Chapter 14 - Interpretive Services
- Chapter 15 - Medical Testimony
- Chapter 16 - Medication Administration and Injections
- Chapter 17 - Mental Health Services
- Chapter 18 - Modifications: Home, Job, and Vehicle
- Chapter 19 - Naturopathic Physicians
- Chapter 20 - Nurse Case Management
- Chapter 21 - Obesity Treatment
- Chapter 22 - Other Services
- Chapter 23 - Pathology and Laboratory Services
- Chapter 24 - Pharmacy Services
- Chapter 25 - Physical Medicine Services
- Chapter 26 - Radiology Services
- Chapter 27 - Reports and Forms
- Chapter 28 - Supplies, Materials, and Bundled Services
- Chapter 29 - Surgery Services
- Chapter 30 - Vocational Services
- Chapter 31 - Washington RBRVS Payment System
- Chapter 32 - Ambulatory Surgery Centers (ASCs)
- Chapter 33 - Brain Injury Rehabilitation Services
- Chapter 34 - Chronic Pain Management
- Chapter 35 - Hospitals
- Chapter 36 - Nursing Home and Other Residential Care Services
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.
2017 Updates and Corrections
On this page, view the following:
- Updates to payment policies or fee schedules.
- Corrections to payment policies or fee schedules.
Payment Policy Updates
|Posting date||Policy Area||Description|
|04/11/2018||Vocational Services||Chapter 30: Vocational Services was updated to reflect State Fund Resume policy changes effective 04/11/2018. These changes can be seen in the attached PDF.|
|03/28/2018||Chapter 22: Other Services||The attached policy for Activity Coaching should have appeared in Chapter 22. Please see attached PDF.|
|03/07/2018||Anesthesia Services||Chapter 4: Anesthesia Services is being corrected to reflect the change to WAC 296-23-245 effective 11/15/16 that all providers billing under type of service ‘N’ (all nurses) are entitled to a maximum of 100% of fee schedule, not 90% as it had been previously. CRNAs billing with modifier –QZ will NOT have their payment reduced to 90% of the fee schedule.|
|11/29/2017||Interpretive Services||Effective January 1, 2018, the fee for sign language interpretation is $1.35 per minute. Sign language interpreters should use code 9978M to bill for direct services between the worker and health care provider, including time spent waiting or completing forms.|
|11/28/2017||Interpretive Services||Chapter 30: Vocational Services was updated to reflect Option 2 policy changes effective October 20, 2017. These changes can be seen in the attached PDF.|
|11/28/2017||Vocational Services||Effective January 1, 2018, for State Fund claims, vocational providers may use over-the-phone interpreters to speak with injured workers with limited English proficiency. Vocational providers who use telephone interpretation services must use CTS Language Link, the company contracted through the Department of Enterprise Services. (For more information, see Chapter 14: Interpretive Services.) Vocational providers can request L&I telephone interpretation services at: CTS Language Link
Toll-free number: 844-303-7212
Website: http://www.ctslanguagelink.com/When requesting interpretation services, the vocational provider must give:
Vocational provider name
CTS bills L&I using the billing code 9979M.
Fee Schedule updates
|Posting date||Description||Updated Version|
|08/07/2019||An error occurred on the 2017 fee schedule, the maximum fee for one unit of 1045M is $252.95 and the maximum fee for 1098M is $126.94.||Effective 07/01/2017|
|05/31/2018||An error appeared on the 2017 fee schedule. A4467 is covered and paid by report.|
|03/20/2018||An error was identified on the 2017 fee schedule; the correct fee for J3301 is $2.38.|
|02/12/2018||1270M– IME Taxi Service should have appeared on the Local Code Fee schedule. It is payable by report.|
|12/18/2017||2018 ASC Fee Schedule Updates Includes:
New ASC codes for 2018, and
Deleted ASC codes effective December 31, 2017.
|New ASC Fee Schedule Updates|
|12/14/2017||New CPT, HCPCS, effective January 1, 2018.||New CPT, HCPCS, effective January 1, 2018|
|12/12/2017||DELETED Procedure Codes - Invalid after December 31, 2017.||PFS_Jan_2018_deletedcodes|
|11/29/2017||Effective January 1, 2018, the fee for sign language interpretation is $1.35 per minute. Sign language interpreters should use code 9978M to bill for direct services between the worker and health care provider, including time spent waiting or completing forms.|
|08/31/2017||L&I has published the Clinical Practice Guideline for Foot and Ankle Diagnosis and Treatment. Per that guideline, effective October 1, 2017, the following codes will require Utilization Review:27610, 27690, 28111, 28232, 28725, 27612, 27691, 28112, 28234, 28730, 27620, 27695, 28113, 28236, 28735, 27625, 27696, 28114, 28238, 28737, 27626, 27698, 28116, 28285, 28740, 27650, 27700, 28118, 28289, 28750, 27652, 27702, 28119, 28292, 28755, 27654, 27703, 28120, 28296, 28760, 27658, 27704, 28122, 28297, 29891, 27659, 27705, 28124, 28298, 29892, 27664, 27707, 28200, 28299, 29894, 27665, 27709, 28202, 28300, 29895, 27675, 27870, 28208, 28302, 29897, 27676, 27871, 28210, 28304, 29898, 27680, 28020, 28220, 28305, 29899, 27681, 28022, 28222, 28306, 29904, 27685, 28024, 28225, 28308, 29905, 27686, 28035, 28226, 28705, 29906, 27687, 28110, 28230, 28715, 29907|
|06/15/2017||Two errors appeared in the original publishing of the fee schedule effective July 1, 2017.
27279 is a covered code with both Non-Facility and Facility fees of $1246.03.
99367 has a Non-Facility fee of $157.86 and a Facility fee of $111.97.
All spreadsheets have been updated to reflect this correction.
Payment Policy Corrections
|Posting date||Policy Area||Description|
Fee Schedule Corrections
|Posting date||Description||Updated Version|
|4/12/2019||E0936 was accidentally omitted from the 2017 fee schedule. It was covered and priced by report.|
|12/14/18||Errors were found on the 2017 fee schedule and are being corrected as follows:
J1020 has a maximum fee of $1.19.
J1030 has a maximum fee of $1.68.
J1040 has a maximum fee of $1.56.
|11/22/2017||An error appeared in the original publishing of the July 1, 2017 fee schedule.
Effective July 1, 2017, the J0587 maximum fee (for both Non-Facility and Facility fees) is $11.75. The fee schedule has been updated to reflect this correction.