Chapter 21: Other Services
Billing & Payment Policies for Healthcare Services provided to Injured Workers and Crime Victims
Return to Billing & Payment Policies
Effective July 1, 2011 |
 Complete Chapter for printing (Republished February 1, 2012) |
Link to updates & corrections
Look for possible updates and corrections to these payment policies
Table of contents
Payment policies:
After hours services
Locum tenens
Provider mileage
Ventilator management services
More info:
Related topics
Payment policy: After hours services
Services that can be billed
CPT® codes 99050 through 99060 will be considered for separate payment in the following circumstances:
- When the provider’s office isn’t regularly open during the time the service is provided, or
- When services are provided on an emergency basis, out of the office, that disrupts other scheduled office visits.
Note: Also see “Payment limits,” below.
Documentation requirements
Medical necessity and urgency of the service must be documented in the medical records and be available upon request.
Payment limits
Only one code for after hours services will be paid per worker per day.
A second day can’t be billed for a single episode of care that carries over from one calendar day to the next.
CPT® codes 99050 through 99060 aren’t payable when billed by:
- Emergency room physicians,
- Anesthesiologists/anesthetics,
- Radiologists, or
- Laboratory clinical staff.
Payment policy: Locum tenens
Who must perform these services to qualify for payment
A locum tenens physician must provide these services.
Link: For information about requirements for “Who may treat,” see WAC 296-20-015 .
Requirements for billing
The department requires all providers to obtain a provider account number to be eligible to treat workers and crime victims and receive payment for services rendered.
When billing for locum tenens services, the locum tenens physician must use HCPCS billing code modifier –Q6 (which is defined as, “Services furnished by a locum tenens physician”).
Note: Modifier –Q6 cannot be billed for services under another provider’s account number.
Payment policy: Provider mileage
Prior authorization
Prior authorization is required for a provider to bill for mileage.
The round trip mileage must exceed 14 miles.
Note: Reimbursement for such provider mileage is limited to extremely rare circumstances.
Requirements for billing
To bill for pre-authorized mileage:
- Round trip mileage must exceed 14 miles, and
- Use local billing code 1046M (Mileage, per mile, allowed when round trip exceeds 14 miles), which has a maximum fee of $4.86 per mile.
Note: (Also see “Prior authorization,” above.)
Payment policy: Ventilator management services
Services that can be billed
The insurer pays for either the:
- Ventilation management service code (CPT® codes 94002-94005, 94660, and 94662), or
- E/M service (CPT® codes 99201-99499),
- But won’t pay both (also see “Payment limits,” below).
Payment limits
The insurer doesn’t pay for ventilator management services when the same provider reports an E/M service on the same day. If a provider bills a ventilator management code and an E/M service for the same day, payment:
- Will be made for the E/M service, and
- Won’t be made for the ventilator management code.
Links: Related topics
| If you’re looking for more information about… | Then go here: |
| Administrative rules for “who may treat” | Washington Administrative Code (WAC) 296-20-015: http://apps.leg.wa.gov/wac/default.aspx?cite=296-20-015 |
| Becoming an L&I provider | L&I’s website: www.Lni.wa.gov/ClaimsIns/Providers/Becoming/default.asp |
| Billing instructions and forms | Chapter 1: Introduction |
| Fee schedules for all healthcare facility services | L&I’s website: http://feeschedules.Lni.wa.gov |
Need more help? Call L&I’s Provider Hotline at 1-800-848-0811.
CPT® codes and descriptions only are © 2010 American Medical Association
