Fee Schedules

2022 Fee Schedules

Effective July 1, 2022

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.

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

2022 Quick Reference Fee Schedule (English) Español (Spanish)

Professional and Facility Services Fee Schedules (July 2022)

Note: These fee schedules have been enhanced with search features for your convenience.

  • Professional Services Fee Schedule — Excel spreadsheet of the complete fee schedule excluding the ASC Fees, AP-DRGs, Hospital Rates and Residential Facility Rates. This fee schedule has been enhanced with a search feature for your convenience.

Note: For your reference here are the code ranges you will find in the professional fee schedule.

    • Evaluation and Management — CPT™ 99202 - 99499
    • Surgery — CPT™ 10004 - 69979
    • Radiology — CPT™ 70010 - 79999
    • Pathology and Laboratory — CPT™ 80047 - 89398 and 0001U - 0222U
    • Medicine — CPT™ 90281 - 99607
    • CPT ™ Category II and III — CPT™ 0001F - 0639T
    • HCPCS — HCPCS A0021 - V5364
    • Medical and Surgical Supplies Codes — HCPCS A4206 - A9999 (For DME Providers)
    • Facility Only Codes — C1300 - S0093
    • Local Codes — Local Codes Listed by Specialty                                                           

Fee Schedules - Comma delimited version with Field Key

Billing & Payment Policies

2022 Billing & Payment Policies

Effective July 1, 2022

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  (2022)

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

2022 Updates and Corrections

Updates

Payment policy updates

Posting date Policy Area Description
01/05/2023 Chapter 10: Evaluation and Management Services We plan on updating our policies with regard to the 2023 AMA E/M updates​ on July 1, 2023. Providers should continue to follow 2022 CPT® codes, descriptors and guidelines for E/M services through June 30, 2023.
12/01/2022 Chapter 15: Medical Testimony Following review, Chapter 15: Medical Testimony​ has several changes. In addition, the fee schedule is increasing. All changes are effective January 1, 2023.​
11/29/2022 Chapter 22: Other Services Sign language interpreters are now able to perform interpretation in-person or via video. See our Chapter 22 Update​ for more details.  Effective January 1, 2023. 
10/31/2022 Chapter 5: Audiology and Hearing Services L&I will not be following the recent Food and Drug Administration (FDA) rule that allows the over the counter purchase, without a prescription, of hearing aids for people who have perceived mild to moderate hearing loss. To receive insurer-purchased aids and services, a worker must have an allowed hearing loss workers' compensation claim and work through an appropriate state fund or self-insured provider.​
09/12/2022 Chapter 25: Physical Medicine Services Speech language pathologists are not subject to the PT/OT daily cap. Speech language pathologists may supervise speech language pathology students if they meet the other requirements outlined in Chapter 25. Effective July 1, 2022.
09/06/2022 Chapter 26: Radiology Services Certain noninvasive cardiac imaging technologies for coronary artery disease are covered with conditions. See L&I’s coverage decision for details. Effective October 1, 2022.
08/30/2022 Chapter 13: Independent Medical Exams 1124M has an updated description in Chapter 13: Independent Medical Exams​ for in-person exams. The temporary telehealth policy​ still allows the use of 1124M for record review.  The record review fee is to reimburse examiners for their time reviewing the medical file when an exam is canceled or the worker is a no-show, and the exam is not rescheduled with the firm. This isn’t the same as a forensic exam (billed using 1146M), where an IME report is required after the file review.
07/01/2022 Chapter 13: Independent Medical Exams This is to clarify that compensation for downloading, printing, and sorting files is bundled into the reimbursement for the examination fees​.
07/01/2022 Chapter 25: Physical Medicine Services Multiwave Locked System (MLS) laser therapy treatment is considered an investigational procedure and is not covered. 1044M may not be used to bill for this or any laser therapy treatment.​

Fee schedule updates

Posting date

 Description Updated Version
06/15/2023 Effective May 11, 2023,  C9803 is deleted. N/A
04/10/2023 Effective May 11, 2023, the following codes are deleted: 
  • G2023
  • G2024
  • U0003
  • U0004
  • U0005

    		•  NA
    03/28/2023 New HCPCS and Deleted HCPCS codes. See file for effective dates. New and Deleted HCPCS April 2023​
    01/12/2023 Effective February 15, 2023, 27415 is covered in ASC settings. The maximum fee is $21,325.28​ and the code is subject to multiple procedure discounting​. N/A
    01/05/2023 The following COVID-19 related codes are not covered effective October 19, 2022: 
    • 91314
    • 91315​
    		 N/A
    01/05/2023 Effective February 6, 2023, several injection codes have updated maximum fees. ​ February 2023 Injection Pricing Changes​ ​
    01/05/2023​ The Department is allowing coverage of the COVID-19 booster vaccine (code 0044A) for immunocompromised workers who reside in a nursing home, group home, or skilled nursing facility, or receiving home health at home. Prior authorization is required. The maximum fee for this code is $40.00. Effective October 19, 2022. N/A
    01/05/2023 The following COVID-19 related codes are not covered effective October 12, 2022:
  • 0144A
  • 0154A
    		•  N/A
    01/04/2023 Effective January 1, 2023, the reimbursement rate for privately-owned vehicle (POV) mileage is increased to $0.66/mile.​ N/A
    12/14/2022 New CPT and HCPCS codes effective January 1, 2023.​​ January 2023 Added codes​​
    12/14/2022 Deleted CPT and HCPCS codes effective December 31, 2022.​ January 2023 Deleted codes​​
    12/14/2022 ASC updates: Added and deleted CPT and HCPCS codes effective January 1​, 2023.​ January 2023 ASC Adds and Deleted codes​​
    11/02/2022 Effective December 2, 2022, pricing for specific vision codes have new values. See file for details. Vision Code Price Changes December 2022​
    10/14/2022 Effective October 1, 2022,  several injection codes have updated maximum fees. October 2022 Injection Pricing Changes​​
    10/10/2022 New HCPCS and Deleted HCPCS codes. See file for effective dates.​ New and Deleted HCPCS October 2022​
    09/30/2022 90611 and 90622 are covered with conditions. These vaccines are for post-exposure prophylactic use only. Monkeypox exposure must be an accepted condition on the claim. Prior authorization is required. Both codes are paid "By report". Effective July 26, 2022. N/A
    05/31/2022 New HCPCS and Deleted HCPCS codes. See file for effective dates.​ New and Deleted HCPCS July 2022

    Corrections

    Payment policy corrections

    Posting date Policy Area Description
    03/31/2023 Chapter 2: Information for All Providers Correcting information on page 30 of Chapter 2: Information for All Providers: To be paid for services, PAs must have a valid individual L&I provider account numbers referencing their supervising physician, and bill for services using their provider account numbers, and use the appropriate billing modifiers. Correcting information on page 38 of Chapter 2: Information for All Providers: Both Physician Assistant Certified (PA-C) and Physician Assistants (PAs) may be paid for completing an ROA or PIR if they are licensed.​
    12/12/2022 Chapter 10: Evaluation and Management Services Page 23 of Chapter 10: Evaluation and Management Services should include speech therapists who are able to bill non-physician codes for telephone calls. Speech therapists may bill 98966, 98967, or 98968. Effective July 1, 2022. ​
    12/05/2022 Chapter 15: Medical Testimony Page 4 of Chapter 15: Medical Testimony incorrectly states record reviews for regular vocational services and forensic vocational services are paid at the same rate. Each service is paid its own rate. For services on or after July 1, 2022, record reviews for forensic vocational services is $27.50/unit- and for services on or after January 1, 2023, record reviews for forensic vocational services are $55.00/unit per the updated policy. For regular vocational services record reviews- the fee is $23.00/unit on or after July 1, 2022, and $46.00/unit on or after January 1, 2023 per the updated policy. The maximum of 25 units is unchanged for these services.​
    10/11/2022 Chapter 35: Hospitals Page 4 of Chapter 35: Hospitals has an incorrect statement about how hospitals are reimbursed for inpatient treatment of crime victims. The statement should read as follows:
    "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."
    08/30/2022 Chapter 4: Anesthesia Services

    Chapter 16: Medication Administration and Injections    		 Chapter 4: Anesthesia Services and Chapter 16: Medication Administration and Injections incorrectly list the CPT® billing codes for dry needling of trigger points as 20552 and 20553. The correct codes are CPT® 20560 and 20561. Providers may bill only one of these codes per date of service. See L&I’s coverage decision for additional details. Effective August 22, 2022.
    07/19/2022 Chapter 27: Reports and Forms Page 5 of Chapter 27: Reports and Forms has incorrect prices listed for the Report of Accident (1040M) when submitted after 5 business days. The correct pricing is $34.44 (6-8 business days after first treatment date) and $24.44 (9 or more business days after first treatment date). Effective July 1, 2022.

    Fee schedule corrections

    Posting date Description Updated Version
    01/02/2024 We’ve identified an error in the Low Outlier Threshold amounts for APR-DRGs 055 and 056. Effective: July 1, 2022​. The following values should have appeared on the 2021/2022/2023 fee schedules starting July 1 of each year, with the corresponding DRG/SOI combinations:

    DRG 055
    SOI 1 - $1,164.92
    SOI 2 - $1,708.35
    SOI 3 – $2,523.86
    SOI 4 - $4,650.78 

    DRG 056
    SOI 1 - $788.16
    SOI 2 - $1,598.11
    SOI 3 – $2,651.11
    SOI 4 - $4,438.67 ​    		 N/A
    12/19/2023 Description: An error has been identified in the Professional Services Fee Schedule. Codes V2783, V2750, V2715, and V2020 should have appeared as by report.
    Effective 07/01/2022. ​    		 N/A
    04/24/2023 An error has been identified in the Anesthesia Fee Schedule. 00797, 00834, 00836, and 00851 should reflect a payment method of not covered and a base source of N/A. 00796, 00813, 00820 and 00842 should reflect a payment method of base/units and base source CMS​. N/A
    02/17/2023 An error has been identified in the Professional Services Fee Schedule. Code 9973M should appear with a rate of $7.50 per encounter. This matches the maximum fee listed in Chapter 14: Interpreter Services.​ N/A
    01/23/2023 An error has been identified in the Professional Services Fee Schedule. Codes 97161, 97162, and 97163 should appear with a rate of $140.84. This matches the daily maximum cap listed in Chapter 25: Physical Medicine Services for PT and OT services.​
    Effective 02/23/2023.    		 N/A
    07/29/2022 An error has been identified in the Professional Services Fee Schedule. Codes 62350 and 62351 were incorrectly listed as only requiring claim manager (CM) approval for prior authorization. They require utilization review (UR). N/A
    07/26/2022 An error has been identified in the Professional Services Fee Schedule. 1104M should appear with a rate of $162.46, effective July 1, 2022. ​ N/A
    07/14/2022 An error has been identified in the Professional Services Fee Schedule. 27299 should have appeared in the fee schedule with prior authorization required through utilization review.​ N/A
    07/14/2022 An error has been identified in the Professional Services Fee Schedule. 95970 should have appeared in the fee schedule as requiring claim manager (CM) prior authorization, not utilization review​. N/A

    Temporary Telehealth Policies

    Temporary Telehealth Payment Policies

    Posting date Policy Area Description
    12/01/2022 Temporary IME Telehealth Policy The Temporary IME Telehealth Policy​​​ allows temporary coverage for independent medical examiners to complete exams via telehealth. This policy is effective 1/1/2023 and expires 8/31/2023. This is an emerging situation, and this policy may be updated as needed. ​
    6/30/2022 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 12/31/2022​. This is an emerging situation, and this policy may be updated as needed.​ ​