Fee Schedules

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.

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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.

2017 Quick Reference Fee Schedule

Professional and Facility Services Fee Schedules (July 2017)

Fee Schedules - Comma delimited version with Field Key

Billing & Payment Policies

2017 Billing & Payment Policies

Effective July 1, 2017

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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)

Professional Services

Facility 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.

Updates & Corrections

2017 Updates and Corrections

On this page, view the following:

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

Updates

Payment Policy Updates

Posting datePolicy AreaDescription
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
Organization name
Claim number
Worker’s name
Language needed
CTS bills L&I using the billing code 9979M.

Fee Schedule updates

Posting dateDescriptionUpdated 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.

Corrections

Payment Policy Corrections

Posting datePolicy AreaDescription
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Fee Schedule Corrections

Posting dateDescriptionUpdated 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.
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