Fee Schedules

2024 Fee Schedules

Effective July 1, 2024

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.

2024 Quick Reference Fee Schedule (English) Español (Spanish)

Professional and Facility Services Fee Schedules (July 2024)

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 — 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

2024 Billing & Payment Policies

Effective July 1, 2024

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   (2024)

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

2024 Updates and Corrections

Updates

Payment policy updates
Posting date Policy Area Description
12/09/2024 All Telehealth Policies Current coverage and policies for services provided via telehealth and audio-only will remain in effect through June 30, 2025. The insurer will not cover the new E/M telehealth and audio-only CPT® codes (98000-98016). Providers must continue to use the covered in-person CPT® codes with the appropriate modifier.
PrEP counseling and safety planning interventions is covered via telehealth. Preventative CPT® E/M codes are not covered for injured workers. Providers must use other appropriate E/M CPT® codes with modifier -GT to bill for these services.
12/03/2024 Chapter 2: Information for All Providers Updates have been made to the Report of Accident [ROA] payment policy to include clarifications regarding basic first aid and when an ROA is required. See Chapter 2: Information for All Providers​ for details. Effective January 1, 2025.​
12/03/2024 Chapter 16: Medication Administration and Injections and Chapter 24: Pharmacy Services and Chapter 23: Pathology and Laboratory Services and Chapter 35: Hospitals​ The insurer will cover up to a 28-day supply of post-exposure prophylaxis [PEP] drugs for HIV when dispensed directly from a Washington State hospital emergency department for proper and necessary treatment of an injured worker or crime victim. Hospitals will be paid using their assigned POAC rate at time of service. Documentation of the PEP HIV drug[s] dispensed, including drug name, NDC, strength, dosage, and quantity must be included in the hospital chart note. Bill using rev code 0017. Don’t include a CPT®/HCPCS code on the line billed with local rev code 0017. For PEP HIV drugs dispensed through a pharmacy, see Chapter 24: Pharmacy Services. Effective January 1, 2025.​
12/03/2024 Chapter 22: Other Services A new policy for services provided via a mobile clinic is now available. This policy is not applicable to providers who are traveling outside their credentialed service location. Providers performing services must have an active provider account number under the mobile clinic. See Chapter 22: Other Services​ for details. Effective January 1, 2025.​
12/03/2024 Chapter 30: Vocational Services A new policy addressing skill enhancement training is now available. This incentive helps workers maintain and build job readiness skills while receiving vocational services. See Chapter 30: Vocational Services​ for details. Effective January 1, 2025.​
12/03/2024 Chapter 3: Ambulance Services Taxis are required to submit form F248-374-000 in addition to their bill. This form takes the place of a standalone report. Effective January 1, 2025. ​
12/03/2024 Chapter 25: Physical Medicine Services Physical therapists (PTs) with an intramuscular needling endorsement may bill for intramuscular needling (“dry needling”) using CPT® 20560 and 20561, effective January 1, 2025.​

PTs must submit a copy of their Washington State endorsement or equivalent qualification from another state to the Department or self-insurer to administer dry needling treatment to workers. All limits for dry needling outlined in Chapter 4: Anesthesia Services and Chapter 16: Medication Administration and Injections apply.

Intramuscular needling isn’t considered acupuncture and can’t be billed using acupuncture codes.
08/01/2024 Chapter 19 Update​ The acupuncture payment policy has been updated to allow treatment for Chronic Migraine. See our Chapter 19 update for details. Effective September 1, 2024.
Fee schedule updates
Posting date Description Updated Version
12/12/2024 CMS has published additional updates. See file for additional adds and deletes​ January 2025 additional codes​
12/04/2024 ASC updates: Added and deleted CPT and HCPCs codes effective January 1, 2025.​ January 2025 ASC Adds and Deleted codes​​
12/04/2024 New CPT and HCPCs codes. Effective January 1, 2025. January 2025 Added Codes​
12/04/2024 Deleted CPT and HCPCs codes. Effective December 31, 2024. January 2025 Deleted Codes​
12/03/2024 Effective January 1, 2025, we are updating the fee for E0635 as follows:
  • E0635 - NU $4019.93
  • E0635 - RR $401.93
    		•  N/A
    12/03/2024 0380R and 0385R are increased to a maximum allowable of $10,000 per job or job site.
    Effective January 1, 2025.     		 N/A
    12/03/2024 29914 and 29915 are covered when hip labral tear co-occurs with femoroacetabular impingement (FAI) syndrome. Utilization review is required. These codes aren’t covered for FAI surgery without hip labral tear, per coverage decision. 29914 has a price of $1,831.79. 29915 has a price of $1,876.77.​ Both codes are part of endoscopy family 29860. Effective January 1, 2025. ​ N/A
    10/07/2024 Services billed with modifier -74 will be reduced to 60% of the provider fee schedule or billed amount, whichever is less. Effective July 1, 2024. N/A
    10/01/2024 Effective November 1, 2024, we've updated the fees for interpreter services as follows:
  • 9984M:  $1.08
  • 9990M:  $0.87
  • 9983M:  $0.70
  • 9996M:  $63.16
    		•  N/A
    09/23/2024 New HCPCS and Deleted HCPCS codes. See file for details. October 2024 PFS Updates​
    08/07/2024 Effective September 1, 2024, we've created a new code for acupuncture related to chronic migraine and priced it as follows​:​
  • 1581M:  $120.70
    		•  N/A
    06/25/2024 New HCPCS and deleted HCPCs. New and deleted HCPS July 2024​
    06/21/2024 Effective July 1, 2024, we are updating the coverage for PET scans. July 2024 UR for PET Codes​
    06/21/2024 Effective July 1, 2024, the ASC Payment amounts for the following codes are being updated to the maximum allowable amounts and are not subject to multiple procedure discounting:
    • 78811:  $1,196.33
    • 78812:  $1,318.05
    • 78813:  $1,318.05
    • 78814:  $1,318.05
    • 78815:  $1,318.05
    • 78816:  $1,318.05
    		 N/A

    ​Corrections

    Payment policy corrections
    Posting date Policy Area Description
    Fee schedule corrections
    Posting date Description Updated Version
    12/16/2024 We've identified two corrections in the January 2025 deleted code file. G9919 and G9920 aren't ending 12/31/24. They remain uncovered. Effective December 1, 2024.​ N/A
    12/12/2024 Description: We've identified an error in the January 2025 added codes file. The following codes should have appeared with pricing from the Professional Services Fee Schedule, not by report. This is effective December 1, 2024. 
  • E1800
  • E1805
  • E1810
  • E1815
  • E1825
    • Only the descriptions of these codes are updated as of January 1, 2025. See the January 2025 added codes file for the revised descriptions.     		 N/A
    12/12/2024 We've identified two corrections in the January 2025 added and deleted code files. C9734 isn't ending 12/31/24. It remains uncovered. M1389 isn't added effective 1/1/25. This is per a recent update from CMS. Effective December 1, 2024. ​ N/A
    11/20/2024 We've identified two errors in the Professional Services Fee Schedule. G2082 should have appeared with a non-facility fee of $1,555.28 and a facility fee of $63.58. G2083 should have appeared with a non-facility fee of $2,201.87 and a facility fee of $63.58. This is effective July 1, 2024.​ N/A
    11/06/2024 We've identified an error in the Professional Services Fee Schedule. Code E0118 -RR should have appeared with a max fee of $78.90. This is effective July 1, 2024.​ N/A
    10/25/2024 An error has been identified in the Professional Services Fee Schedule. Code 23929 should have appeared with an FSI of N for by report, not B or bundled. This is effective July 1, 2024.​ N/A
    06/25/2024 The following codes are deleted from the ASC Fee Schedule effective July 1, 2024:
  • C9113
  • J2780
  • J9371
    		•  N/A