Fee Schedules

2020 Fee Schedules

Effective Oct. 1, 2020

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.

Please make sure to review our Temporary Telehealth Payment Policies on the tab above.

2020 Quick Reference Fee Schedule

Professional and Facility Services Fee Schedules (July 2020)

Fee Schedules - Comma delimited version with Field Key

Billing & Payment Policies

2020 Billing & Payment Policies

Effective October 1, 2020

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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 (2020)

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

2020 Updates and Corrections

Updates

Payment policy updates

Posting date Policy Area Description
5/17/2021 Nursing Homes Nursing Home Payment Methodology Change
Effective for dates of service on or after July 1, 2021, the department will begin using a modified version of the HIPPS (Health Insurance Prospective Payment System) coding system when processing billings from nursing homes.
5/14/2021 The following COVID-19 related codes have been updated. The Department is allowing the coverage of the COVID-19 vaccine for immunocompromised workers who reside in a nursing home- group home- skilled nursing facility- or are receiving home health at home- and have prior authorization. The Department has also updated its fees for the following codes: 
  • 91304- effective 3/15/2021- $0.00
  • 0041A-0042A- effective 3/15/201- $40.00
  • M0243- effective 5/6/2021- $450.00
  • M0244- effective 5/6/2021- $750.00
  • M0246- effective 5/6/2021- $750.00
The following codes are end-dated effective 5/6/2021:
  • M0239
  • Q0239
  • This information may be updated as the situation develops. 
    12/30/2020 Effective 1/1/2021 -The Department is now allowing coverage of the COVID-19 vaccine for immunocompromised workers who reside in a nursing home- group home- skilled nursing facility- or are receiving home health at home- are receiving this care due to an industrial injury- and have prior authorization. The Department has also updated its fees for the following codes related to the Pfizer and Moderna vaccines:   
    • 91300-91301 - $0.00
    • 0001A-0002A - By Report
    • 0011A-0012A - By Report
    • Q0239 - $0.00
    • M0239 - By Report
    • Q0243 - $0.00
    • M0243 - By Report
    This information may be updated as the situation develops.
    12/18/2020 Chapter 10: Evaluation and Management Services Continue using 2020 CPT-R- codes and their descriptions- coding- and documentation requirements. This applies to 99201-99499. Chapter 10 will update in MARFS 2021.
    10/01/2020 Chapter 30: Vocational Services An error occurred in the payment policy, the maximum fee for 0823V is $9.70.

    Fee schedule updates

    Posting date Description Updated Version
    3/23/2021 Deleted ASC codes as of March 31, 2021 Deleted ASC codes March 2021
    3/19/2021 New HCPCS codes effective April 1, 2021 and Deleted HCPCS codes as of March 31, 2021 New and Deleted HCPCS April 2021
    1/26/2021 The L&I fee schedule has been updated to include the following codes. Prior authorization is required for type of service 3- N- and X. Codes are effective 10/1/2020- except for 0202U- which is effective 5/20/2020. Bill by report. 
    • 0202U
    • 0225U
    • 0226U
    • 86408
    • 86409
    • 86413
    N/A
    1/11/2021 Description: Effective 1/1/2021- reimbursement for privately owned vehicle -POV- mileage is $0.56/mile. N\A
    12/23/2020 ASC updates: Added and deleted CPT and HCPCS codes effective Jan. 1, 2021. ASC January 2021 Fee Updates
    12/22/2020 Professional Fee Schedule Updates: New CPT and HCPCS effective Jan. 1, 2021. New CPT and HCPCS effective January 1- 2021
    12/22/2020 Deleted Procedure Codes for 2020 effective Dec. 31, 2020. Deleted Codes effective 12/31/2020
    10/07/2020 An error has been identified in the Independent Medical Exam fees in the Professional Services Fee Schedule file. See Professional Services Fee Schedule.

    Corrections

    Payment policy corrections

    Posting date Policy Area Description
    11/06/2020 Chapter 2: Information for all Providers Page 40 of Chapter 2: Information for All Providers incorrectly notes the max fee via FileFast/HIE - State Fund only -additional $10 incentive. Within five days- the fee should be $52.31- within 6-8 days- it should be $42.31- and 9 days or more the fee is $32.31 when filing an ROA online.
    10/12/2020 Chapter 35: Hospitals MARFS Chapter 35, Hospitals, on page 35-4, incorrectly stated the Crime Victims Program uses DSHS POAC rates. The Crime Victims Program uses L&I POAC rates. The paragraph should read:
    Crime Victims Compensation Program payment methods
    Services for hospital inpatient care provided to crime victims covered by the Crime Victims Compensation Program are paid using L&I POAC rates (see WAC 296-30-090).

    Fee schedule corrections

    Posting date Description Updated Version
    5/24/2021 An error has been identified in the Pathology and Laboratory fee schedule. Effective 6/25/2020- 87426 requires prior authorization. ​ N/A
    5/14/2021 An error has been identified in the HCPCS fee schedule file. Effective 10/1/2020 E2402 is payable at the monthly rate of $1-493.10. ​ N/A
    3/30/2021 An error has been identified in the HCPCS fee schedule file. Effective 10/1/2020 E0240 is payable By Report. N/A
    2/18/2021 99406 and 99407 were listed on the 2020 fee schedule as not covered in error. As of 10/01/2020 the code maximum fees are:
  • 99406 Non Fac $28.49 and Fac $22.66.
  • 99407 Non Fac $53.73 and Fac $48.56.
  • N/A
    2/18/2021 Description: An error was identified in the Pathology and Laboratory fee schedule. 87635 is covered but requires prior authorization.  N/A
    2/18/2021 Description: An error has been identified in the Medicine fee schedule file. Several codes were missing their -TC or -26 modifier fees. The file is now updated- effective 10/1/2020. See Medicine for update.
    2/10/2021 Description: An error has been identified in the HCPCS fee schedule file. The following codes require prior authorization:
  • U0001
  • U0002
  • U0003
  • U0004 
  • See HCPCS for update
    11/10/2020 An error has been identified in the Medicine fee schedule. The fees for the following are effective 11/10/2020:
  • 98966 - non-facility $26.54, facility $23.95
  • 98967 - non-facility $51.14,  facility $48.56
  • 98968 - non-facility $75.10, facility $71.86
  • N/A
    11/10/2020 An error has been identified in the HCPCS fee schedule. The following codes are paid by report effective 10/1/2020:
    A0080, A0090, A0100, A0110, A0120, A0130, A0140, A0160, A0170, A0180, A0190, A0210
    N/A
    11/10/2020 An error has been identified in the HCPCS fee schedule. E0118 was incorrectly priced. The monthly rental price is $72.54. N/A
    10/30/2020 An error has been identified in the HCPCS file. The license requirements in the file were missing. See HCPCS for license requirements.
    10/23/2020 An error has been identified in the HCPCS fee schedule. Code J7322 is now paid By Report. N/A
    10/08/2020 The following information is missing from the Radiology Fee Schedule key field.
  • MSI -51 column value 6: Modifier -51 may be valid. Subject to 25% reduction of the second highest and subsequent procedures to the TC of diagnostic cardiovascular services.
  • MSI -51 column value 7: Modifier -51 may be valid. Subject to 20% reduction of the second highest and subsequent procedures to the TC of diagnostic opthamology services.
  • N/A
    10/08/2020 An error has been identified in the impairment rating fee schedule. The impairment rating fees for 2020 are:
    1190M - $618.40
    1191M - $618.40
    1192M - $773.00
    1194M - $618.40
    1195M - $773.00
    N/A
    10/06/2020 An error has been identified- 28446 is a non-covered procedure. See Coverage Decision for further information.
    Temporary Telehealth Payment Policies

    Temporary Telehealth Payment Policies

    Posting date Policy Area Description
    2/12/2021 Temporary Telehealth Services Description: Acute care hospitals may bill Q3014 on a UB-04 form when the patient is a registered outpatient- and staff are supporting the professional telehealth service. In this case- the acute care hospital may bill the originating site facility fee Q3014. Use G0463 if the patient and the practitioner are both located within the acute care hospital during a telehealth visit. This update aligns with L&I’s temporary payment policies effective March 9- 2020- and will expire June 30- 2021- unless the Department determines an extension is appropriate.
    2/26/2021 Temporary Policy for Services Provided by Audio Only When services are provided by telephone- bill multiple units as appropriate. For calls exceeding 30 minutes- multiple units of 99441-99443 or 98966-98968 may be billed. For example- if the duration of the call is 60 minutes- bill 2 units of 99443 or 98968. Use other time based codes as defined by their minutes to add to time beyond 99441 or 98966. Documentation should support why the visit occurred by phone instead of telehealth or in person- and contain the same elements as defined in the temporary telehealth policies- such as worker consent for the visit to occur by phone. For additional telephone call requirements- see Chapter 10: Evaluation and Management. This is retroactive to March 9th- 2020.
    12/7/2020 Temporary Telehealth Policy for Naturopaths To help support containment of the COVID-19 outbreak- the Temporary Telehealth Policy for Naturopaths allows temporary coverage for naturopath exams via telehealth. This policy is effective 3/9/2020 and expires 12/31/2021. This is an emerging situation- and this policy may be updated as needed.
    4/10/2020 Temporary Telehealth IME and Record Review Policy To help support containment of the COVID-19 outbreak, the Temporary IME and Record Review policy allows temporary coverage for independent medical examiners to complete exams via telehealth. This policy is effective 3/9/2020 and expires 12/31/2021​. This is an emerging situation, and this policy may be updated as needed.
    4/10/2020 Temporary Telehealth Policy for Activity Prescription Forms (APFs) To help support containment of the COVID-19 outbreak, the Temporary Telehealth Policy for Activity Prescription Forms (APFs) allows temporary coverage for providers to complete APFs via telehealth. This policy is effective 3/9/2020 and expires 12/31/2021​. This is an emerging situation, and this policy may be updated as needed.
    4/10/2020 Temporary Telehealth for Initial Evaluation policy To help support containment of the COVID-19 outbreak, the Temporary Telehealth Policy for Initial Evaluation allows the temporary coverage of new patient evaluation and management services. This policy is effective 3/9/2020 and expires 12/31/2021​. This is an emerging situation, and this policy may be updated as needed.
    4/6/2020 Temporary TeleBrain Rehab policy To help support containment of the COVID-19 outbreak, the Temporary TeleBrainRehab Payment Policy allows the temporary coverage of telehealth for outpatient brain injury rehabilitation services. This policy is effective 3/9/2020 and expires 12/31/2021​. This is an emerging situation, and this policy may be updated as needed.
    4/3/2020 Temporary Interpreter Services via Video or Telephone Policy To help support containment of the COVID-19 outbreak, the Temporary Interpretive Services via Video or Telephone Policy allows interpreters to provide service either by video or by telephone. This policy is effective 3/9/2020 and expires 6/30/2021. This is an emerging situation, and this policy may be updated as needed.
    3/9/2020 Temporary Telerehab Work Hardening Policy To help support containment of the COVID-19 outbreak, the Temporary Telerehab Work Hardening payment policy allows providers to use the worker’s home as an origination site for treatment following the initial in person evaluation. This policy is effective 4/01/2020, and expires 12/31/2021​. This is an emerging situation, and this policy may be updated as needed.
    3/25/2020 Temporary TeleSIMP Policy To help support containment of the COVID-19 outbreak, the temporary teleSIMP policy allows medical providers to use home as an origination site in some instances to treat injured workers. This policy is effective 3/9/2020, and expires 12/31/2021​. This is an emerging situation, and this policy may be updated as needed.
    3/20/2020 Temporary Telerehab policy To help support containment of the COVID-19 outbreak, the temporary telerehab policy allows physical therapists, occupational therapists, and speech language pathologists to use telehealth as a modality to deliver services to established patients in outpatient settings. This policy is effective 3/9/2020 and expires 12/31/2021​.
    3/16/2020 Temporary Telehealth Policy To help support containment of the COVID-19 outbreak, the temporary telehealth policy allows medical providers to use home as an origination site in some instances to treat injured workers. This policy is effective 3/9/2020, and expires 12/31/2021​. This is an emerging situation, and this policy may be updated as needed.