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Highlights of Changes

This Medical Aid Rules and Fee Schedules (fee schedule) is effective for services provided on or after July 1, 2006. These highlights are intended for general reference; they are not a comprehensive list of all the changes in the fee schedule. Refer to the 2006 CPT™ and HCPCS coding books for complete code descriptions and lists of new, deleted or revised codes.

Washington Adminstrative Code (WAC) and Payment Changes

• Cost of living adjustments were applied to RBRVS and anesthesia services and to most local codes.
• WAC 296-20-135:

  Increased	From	To
  RBRVS conversion factor	$52.23	$54.22
  Anesthesia conversion factor	$2.90 per minute ($43.50 per 15 minutes)	$2.97 per minute ($44.55 per 15 minutes)

• WAC 296-20-220 and WAC 296-23-230 increased the maximum daily cap for physical and occupational therapy services to $109.92.

Policy & Fee Schedule Additions, Changes and Clarifications

Introduction

• Information on the Claim and Account Center was added.
• Fax numbers for Report of Accident and other claim forms were added.
• Provider Bulletin listing was removed in favor of a link to the department's web site.

Professional Services

• IME section was added.
• Split (balance) billing process was clarified.
• Using Modifier -25 was updated.
• After hours policy was updated.
• Teleconsultation policy was updated.
• Powered traction billing was clarfied.
• TENS policy was enhanced.
• Osteopathic medicine use of E&M codes was clarified.
• Obesity treatment was updated.

Facility Services

• Fees including hospital AP-DRG and per diem rates, residential facilities, brain injury programs, pain management programs and ambulatory surgery centers have been updated.
• Acquisition cost policy was clarified as it relates to hospitals.

Appendices that have been updated

• Preferred drug list.
• Other appendicies updated with new codes.

Fee Schedules that have been updated

• Professional fees.
• Hospital AP-DRG outlier thresholds.
• Ambulatory surgery center fees.
• Hospital percent of allowed charge (POAC) factors.
• Hospital ambulatory payment classification (APC) rates.
• Residential fee schedules.

L&I's specialty codes have been better organized.