Fee Schedules

2018 Fee Schedules

Effective July 1, 2018.

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.

2018 Quick Reference Fee Schedule

Professional and Facility Services Fee Schedules (July 2018)

Fee Schedules - Comma delimited version with Field Key

Billing & Payment Policies

2018 Billing & Payment Policies

Effective July 1, 2018

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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 (2018)

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

2018 Updates and Corrections

On this page, view the following:

Updates

Payment Policy Updates

Posting datePolicy AreaDescription
08/30/19 Chapter 11: Home Health Services Two errors were made in Chapter 11: Home Health Services. The correct pricing for G0300 is $37.80 and for S9124 it is $44.38.
5/7/2019 Chapter 14: Interpreter Services Effective 5/7/2019, video remote interpreting is not available.
4/1/2019 Chapter 25: Physical Medicine Services Effective: 4/25/2019, the attached policy is appended to the Physical Medicine Services chapter of MARFS. This policy allows supervised PT and OT students to assist with L&I claims. Please see the attached PDF.
11/30/2018 Chapter 18: Modifications: Home, Job and Vehicle;Chapter 30: Vocational Services Effective 1/1/2019, L&I has made significant changes to Medical Aid Rules and Fee Schedules Chapter 30: Vocational Services. Please see the PDF of Chapter 30 in this table. Effective 01/01/2019, the payment policy for job modifications and pre-job modifications is being removed from Chapter 18: Modifications: Home, Job and Vehicle and can now be found in the updated Chapter 30: Vocational Services. Chapter 18: Modifications: Home, Job and Vehicle (Revised) Chapter 30: Vocational Services (Revised)

Fee Schedule Updates

Posting dateDescriptionUpdated Version
12/11/2019 Professional Fee Schedule Updates: New CPT and HCPCS effective January 1, 2020 New CPT & HCPCS effective 
January 1, 2020
6/3/2019 The following codes are payable effective 01/01/2019
96136 - Facility Fee $88.69, Non-Facility Fee $45.97
96137 - Facility Fee $82.22, Non-Facility Fee $35.61
Effective 01/01/2019
4/29/2019 An error occurred on the 2018 fee schedule, the maximum fee for one unit of 1045M is $255.48 and the maximum fee for 1098M is $128.21.
12/13/2018 Professional Fee Schedule Updates: New CPT and HCPCS effective January 1, 2019. New CPT & HCPCS effective
January 1, 2019
12/13/2018 Ambulatory Surgery Center Fee Schedule Updates: New codes effective January 1, 2019 and deleted codes effective December 31, 2018 New ASC codes effective
January 1, 2019 and deleted codes effective December 31, 2018
12/12/2018 DELETED Procedure Codes – Invalid after December 31, 2018 January 2019 Deleted Codes
9/4/2018 Q5108 is covered effective October 1, 2018. The code is paid ‘By Report’ and does not require prior authorization. N/A
9/21/2018 1097M - Review of Physical Capacities Evaluation Report (review) was added to the fee schedule effective 07/01/2018. This code should be used to bill the department when a provider reviews the a Physical Capacities Evaluation rather than 1038M N/A
9/21/2018 1729M - PGAP Coach Mileage was added to the fee schedule effective 11/21/2017 and is payable at the State Rate for mileage. N/A
9/21/2018 1728M – PGAP Coach Travel Time was added to the fee schedule effective 11/21/2017 and has a non-facility fee of $7.08 and a facility fee of $6.96. N/A
9/21/2018 Errors were found on the fee schedule and are being corrected as follows:
Codes 27412, 81539, J7330 are not covered
Codes 28800, 28805, 29844, 29845, 47544 require Utilization review.
Code 2014M has a non-facility fee of $1.60 and a facility fee of $1.60
N/A

Corrections

Payment Policy Corrections

Posting datePolicy AreaDescription
10/18/2019 Chapter 27: Reports and Forms An error occurred in the payment policy, the maximum fee for S9982 is $0.54.
8/07/2019 Chapter 10: Evaluation and Management An error occurred in the payment policy, the maximum non-facility fee for 98969 is $46.97.

Fee Schedule Corrections

Posting dateDescriptionUpdated Version
8/30/2019 An error was found on the fee schedule. The correct fee for 90371 is $180.14.
4/12/2019
  • 96138 and 96139 are covered effective 01/01/2019. Both codes have a maximum facility and non-facility fee of $73.16.
  • Errors were found on the 2018 fee schedule, and are being corrected as follows:
    • E0935 has a maximum facility and non-facility fee of $25.32 per day.
    • E0936 is priced by report.
12/14/2018 Errors were found on the 2018 fee schedule and are being corrected as follows:
1001M has a maximum fee of $127.08.
2050A has a maximum fee of $44.73.
N/A