Effective March 25, 2013 the department is placing restrictions on who may bill for non-CLIA waived testing.

Non-CLIA Waived Testing

• Requirements for billing
  Complex or moderately comlex clinical pathology procedures that are not waived under the Clinical Laboratory Improvement Act (CLIA) must be performed in laboratories that are accredited or have a categorized staus under the State Department of Health or equivalent accrediting body.
• Payment limits
  Payment for complex and moderately complex clinical pathology procedures will not be paid to any provider that only has a CLIA certificate of waiver or the Provider Performed Microscopic Procedure certificate.

The following codes will require utilization review effective 10/1/2012.

New APR-DRG weights, high and low outlier thresholds and average lengths of stay effective for dates of service beginning October 1, 2012.
DRG Per Diem Rates and DRG Base Rates are not changing.

APRDRG Assignment effective October 1, 2012.
APRDRG Assignment Field Key effective October 1, 2012.
APRDRG Assignment effective October 1, 2012.

Effective February 27th, 2013, providers can bill for interest on medical bills for self-insured claims only. While the effective date to start billing self-insured providers for interest is 2/27/13; providers may bill interest on proper medical bills on self-insured claims for dates of service occurring before 2/27/13.
Providers use both of the following to bill interest:

• Local code 1159M.
• The Self-Insurance Medical Bill Interest Calculator http://www.lni.wa.gov/Modules/SIMBIC/default.asp to figure the correct interest due. (see next page for instructions)

Effective 1/1/2013, CPT® code 90863, Management of prescriptions and review of medication, when performed with psychotherapy, is not covered. Psychiatrists and psychiatric ARNPs should bill an appropriate E/M procedure code for this service.

Procedure Code 64555 will be "Not Covered" by the department effective January 1, 2013.

Correction to codes in the microsurgery section. These CPT® codes aren't allowed with CPT® 69990.

None at this time...