Fee Schedules

2023 Fee Schedules

Effective July 1, 2023

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.

2023 Quick Reference Fee Schedule (English) Español (Spanish) - Coming Soon!

Professional and Facility Services Fee Schedules (July 2023)

Note: These fee schedules have been enhanced with search features for your convenience. Enable Macros in Excel for the files below to open without errors. These files are best viewed in the desktop application and not the web browser.

  • 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

2023 Billing & Payment Policies

Effective July 1, 2023

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  (2023)

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

2023 Updates and Corrections

Updates

Payment policy updates

Posting date Policy Area Description
02/15/2024 Chapter 16: Medication Administration and Injections​ Hyaluronic acid for osteoarthritis of the knee is no longer covered. The payment policy on page 6 and 7 is removed from this chapter. See the updated coverage decision for details. Effective March 1, 2024.
02/06/2024 Chapter 2: Information for All Providers​ Effective February 9, 2024, links pointing to ProviderOne in Chapter 2: Information for All Providers (page 10) are replaced with the following URL: Become a Provider (wa.gov) ​
12/18/2023 Chapter 25: Physical Medicine Services​ A new policy for Work Rehabilitation is now available. Effective February 2, 2024.
12/18/2023 Chapter 10: Evaluation & Management (E/M) Services​ Additional language has been added to page 10-17. See the underlined text below: “The insurer won’t reimburse PT/OT and/or speech language pathologists for team conferences with members of the same clinic or care organization’s physical medicine team unless part of an approved work rehabilitation program care conference.” Effective February 2, 2024.
12/01/2023 Chapter 17: Mental Health Services​ Master's Level Therapists may treat mental health conditions per L&I's mental health treatment guideline, but they may not perform mental health evaluations to establish a diagnosis. Effective January 1, 2024.
12/01/2023 Chapter 33: Brain Injury Rehabilitation Services​ Brain Injury Rehabilitation providers must now maintain CARF accreditation in Outpatient Medical Rehabilitation Program – Interdisciplinary with Brain Injury Specialty designation and provide the Department of Labor and Industries (L&I) with documentation of satisfactory recertification including the latest CARF Accreditation Report. This information is required to be submitted to the Department within 30 days of receipt of the report. A provider’s account will be inactivated if CARF accreditation expires or this information is not received from the provider. It is the provider’s responsibility to notify L&I when an accreditation visit is delayed. Effective January 1, 2024.​
12/01/2023 Chapter 22: Other Services ​ We updated the payment policy for Behavioral Health Interventions. The policy applies to Master’s Level Therapists [MLTs] and providers who use behavioral health intervention CPT® codes 96156-96159. All other providers who use Evaluation and Management Services (E&M) may also use those codes for behavioral health interventions. See our Chapter 22 Update​ for details. Effective January 1, 2024. 
12/01/2023 Chapter 30: Vocational Services​ A new policy addressing vocational school refunds is now available. This policy addresses how schools submit refunds for workers who do not complete the full educational course. See Chapter 30: Vocational Services​ for details. Effective January 1, 2024.
12/01/2023 Chapter 22: Other Services​ Musculoskeletal surgeons participating in the Surgical Quality Care Program (SQCP) may receive incentives for implementing occupational health best practices, which are designed to improve the outcomes for workers injured on the job. Only surgeons who are part of the SQCP may take part in this incentive program. See our Chapter 22 Update​ for details. Effective January 1, 2024.
12/01/2023 Chapter 22: Other Services A new policy​ is now available for lodging providers for any dates of stay after January 1, 2024. Lodging providers must have an active L&I provider account number for reimbursement. Prior authorization is required.​
12/01/2023 Chapter 27: Reports and Forms​ Master's Level Therapists may bill 99080 when providing mental health treatment only. It is not covered for behavioral health and interventions. Effective January 1, 2024. 
10/05/2023 Chapter 25: Physical Medicine Services We've changed our rules regarding low-level laser therapy. See our Chapter 25 Update​ for details. Effective November 1, 2023.
09/15/2023 Chapter 17: Mental Health Services Transcranial magnetic stimulation is limited to 30 sessions per authorized course of treatment. See our Chapter 17 Update​ for details. Effective October 15, 2023.​
08/15/2023 Chapter 10: Evaluation & Management (E/M) Services​ For additional documentation guidelines and requirements regarding new and established outpatient office visits and prolonged services, providers should reference the 2021 AMA E/M guideline updates. The 2023 AMA E/M guideline updates are still applicable to all other types of E/M visits. ​
08/09/2023 Chapter 2: Information for All Providers Groups or facilities, agencies, organizations or institutions must have a Federal Tax Identification Number before submitting an application in ProviderOne.​
08/08/2023 Chapter 13: Independent Medical Exams We are updating Chapter 13: Independent Medical Exams​​ to include telehealth services.

Fee schedule updates

Posting date

Description Updated Version
02/12/2024 Codes 9977M and 9982M will no longer be covered effective February 29, 2024.Codes 9970M (video interpretation – Spanish) and 9971M (video interpretation – other languages) will be covered for DES-contracted vendor CTS Language Link only effective March 1, 2024. N/A
01/31/2024 1086M has a code description of Best Practices Incentive - Surgical. This aligns with the Chapter 22: Other Services policy update published on 12/01/2023 for the Surgical Quality Care Program (SQCP) incentives. Effective January 1, 2024 N/A
01/03/2024 Effective January 1, 2024, the reimbursement for privately-owned vehicle (POV) mileage is increased to $0.67/mile.​ N/A
12/19/2023 ASC updates: Added and deleted CPT and HCPCS codes effective January 1​, 2024.​ January 2024 ASC Adds and Deleted codes ​
12/18/2023 We’ve created new codes for the Work Rehabilitation program and priced them as follows:

1023M: $72.25
1024M: $60.24

Fees for existing codes (1001M, 97545, and 97546) remain unchanged.  Effective February 2, 2024.
N/A
12/18/2023 Deleted CPT and HCPCS codes. Effective December 31, 2023.  January 2024 Deleted Codes
12/18/2023 New CPT and HCPCS codes. Effective January 1, 2024. January 2024 Added Codes
12/01/2023 We’ve updated our fees for codes S9122-S9124 to the following:

S9122: $43.00
S9123: $86.43
S9124: $62.44

Effective January 1, 2024.
N/A
12/01/2023 1085M and 1071M are no longer covered. ​Effective January 1, 2024. N/A
09/26/2023 New HCPCS and Deleted HCPCS codes. See file for details.​ New and Deleted HCPCS October 2023​​
09/15/2023 J9041 requires prior authorization.​ Effective October 1, 2023. N/A
07/18/2023 90739 is covered with conditions. This is for post-exposure prophylaxis use only. Prior authorization is required. This code pays "By Report". ​Effective July 1, 2023. N/A
06/15/2023 C9803 is deleted. Effective May 11, 2023. N/A
06/15/2023 New HCPCS and deleted HCPCS codes July 2023 Adds and Deletes

Corrections

Payment policy corrections

Posting date Policy Area Description
10/19/2023 Chapter 19: Naturopathic Physicians and Acupuncture Services​ Page 5 of Chapter 19: Naturopathic Physicians and Acupuncture Services​ links the incorrect coverage decision in reference to treatment of chronic migraine or chronic tension-type headaches. It should link to this L&I coverage decision.​
10/18/2023 Chapter 30: Vocational Services  The Quality assurance by vocational firms link is incorrect. Providers should reference the Vocational Quality Assurance Plan. 
08/15/2023 Chapter 2: Information for All Providers The incorrect form number was linked for the General Provider Billing Manual. Providers should reference form F245-432-000.​​
08/03/2023 Chapter 23: Pathology and Laboratory Services​ Page 13 of Chapter 23: Pathology and Laboratory Services incorrectly lists the fee for 2 automated tests that are components of 80061. The correct automated test maximum fee for 2 tests performed as part of panel 80061 is $11.15. The correct maximum payment for the example listed is $22.78. Effective July 1, 2023.​

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, 2023​. 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 An error has been identified in the Professional Services Fee Schedule. Codes V2783, V2750, V2715, and V2020 should have appeared as by report.
Effective 07/01/2023. ​
N/A
09/15/2023 An error has been identified in the Professional Services Fee Schedule. Code 76496 isn't covered. Effective September 15, 2023. ​ N/A
08/02/2023 An error has been identified in the Professional Services Fee Schedule. The following codes should have appeared on the 2023 fee schedule with these corresponding values.
These fees are effective July 1, 2023
  • 80047  $13.66
  • 80048  $13.66
  • 80050  $48.55
  • 80051  $13.66
  • 80053  $18.25
  • 80055  $88.22
  • 80061  $22.78
  • 80069  $13.66
  • 80074  $67.63
  • 80076  $13.66
  • N/A
    08/01/2023 We've identified an error in the Local Codes Listed By Specialty Fee Schedule. Case Management codes 1292M-1299M are erroneously included. These codes are not in effect and are not billable. The correct Case Management codes are 1220M-1225M. Effective July 1, 2023. N/A
    07/24/2023 We've identified an error in the Professional Services Fee Schedule. Code 8902H requires prior authorization.​ N/A
    07/10/2023 An error has been identified in the Professional Services Fee Schedule. The following codes aren't active: A9599, C9055, C9140, C9485, C9486, J9199. This is effective June 30, 2023. N/A
    07/06/2023 An error has been identified in the Professional Services Fee Schedule. Code 8901H should appear with a rate of $15.74. This is effective July 1, 2023. 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 independent medical examiners to complete exams via telehealth. This policy became effective January 1, 2023 and expires on August 31, 2023. This is an emerging situation, so this policy may be updated as needed. ​