2019 Fee Schedules
Effective July 1, 2019.
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.
2019 Quick Reference Fee Schedule
Professional and Facility Services Fee Schedules (July 2019)
- Professional Services Fee Schedule – Excel spreadsheet of the complete fee schedule excluding the ASC Fees, AP-DRGs, Hospital Rates and Residential Facility Rates.
- Anesthesia — CPT™ 00100 - 01999
- Evaluation and Management — CPT™ 99201 - 99499
- Surgery — CPT™ 10021 - 69990
- Radiology — CPT™ 70010 - 79999
- Pathology and Laboratory — CPT™ 80047 - 89356
- Medicine — CPT™ 90281 - 99607
- CPT ™ Category II and III — CPT™ 0001F - 0192T
- HCPCS — HCPCS A0021 - V5364
- Medical and Surgical Supplies Codes — HCPCS A4206-A9999
(For DME Providers) - Facility Only Codes — C1300 - S0093
- Local Codes by Code — 0401A - 5093V, R0310 - R0392, & V0028
- Local Codes by Specialty — 0401A - 5093V, R0310 - R0392, & V0028
- ASC Fee Schedules — All approved codes
- APR-DRG Assignment — Version 31
- Hospital Rates
- Residential Facility Rates
Fee Schedules - Comma delimited version with Field Key
- Complete fee schedule excluding the ASC Fees, AP-DRGs, Hospital Rates and Residential Facility Rates, Field Key
- Anesthesia
- Ambulatory Surgery Center, Field Key
- APR-DRG, Field Key
- Hospital, Field Key
2019 Billing & Payment Policies
Effective July 1, 2019
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 (2019)
- Chapter 1 - Introduction
- Chapter 2 - Information for All Providers
Professional Services
- Chapter 3 - Ambulance Services
- Chapter 4 - Anesthesia Services
- Chapter 5 - Audiology and Hearing Services
- Chapter 6 - Biofeedback, Electrocardiograms (EKG), Electrodiagnostic services, and Extracorporeal shockwave therapy (ESWT)
- Chapter 7 - Chiropractic Services
- Chapter 8 - Dental Services
- Chapter 9 - Durable Medical Equipment (DME)
- Chapter 10 - Evaluation and Management (E/M) Services
- Chapter 11 - Home Health Services
- Chapter 12 - Impairment Rating Services
- Chapter 13 - Independent Medical Exams (IME)
- Chapter 14 - Interpretive Services
- Chapter 15 - Medical Testimony
- Chapter 16 - Medication Administration and Injections
- Chapter 17 - Mental Health Services
- Chapter 18 - Modifications: Home, Job, and Vehicle
- Chapter 19 - Naturopathic Physicians
- Chapter 20 - Nurse Case Management
- Chapter 21 - Obesity Treatment
- Chapter 22 - Other Services
- Chapter 23 - Pathology and Laboratory Services
- Chapter 24 - Pharmacy Services
- Chapter 25 - Physical Medicine Services
- Chapter 26 - Radiology Services
- Chapter 27 - Reports and Forms
- Chapter 28 - Supplies, Materials, and Bundled Services
- Chapter 29 - Surgery Services
- Chapter 30 - Vocational Services
- Chapter 31 - Washington RBRVS Payment System
Facility Services
- Chapter 32 - Ambulatory Surgery Centers (ASCs)
- Chapter 33 - Brain Injury Rehabilitation Services
- Chapter 34 - Chronic Pain Management
- Chapter 35 - Hospitals
- Chapter 36 - Nursing Home and Other Residential Care 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.
2019 Updates and Corrections
Updates
Payment policy updates
Posting date | Policy Area | Description |
---|---|---|
03/09/2020 | Other Services | An error occurred and incorrect information accidentally appeared in this policy. The Locum Tenens policy as it appears in the chapter is redacted and replaced with the following language which should have appeared in Chapter 22: Other Services, Locum Tenens: a locum tenens physician must provide these services. The department requires all providers to obtain a provider number to be eligible to treat workers and crime victims and receive payment for services rendered. Modifier –Q6 isn’t covered and the insurer won’t pay for services billed under another provider’s account. |
01/02/2020 | Information for All Providers | Virtual Reality (VR) as a modality or vehicle for the delivery of otherwise billable therapy services (per current therapy services payment policy) is covered by the Department. There isn’t a separately billable service for reimbursement when VR is used. |
01/01/2020 | Vocational Services | Throughout Chapter 30: Vocational Services, “Early Intervention” is renamed “Vocational Recovery” to align with amendments to WAC 296-19A, which were adopted Oct. 22, 2019. Billing codes are the same; only the name of the initial service is changed. Effective 01/01/2020. |
08/30/2019 | Home Health Services | Two errors were made in Chapter 11: Home Health Services. The correct pricing for G0300 is $37.80 and for S9124 it is $44.38. |
08/07/2019 | Independent Medical Exams | Chapter 13 has been updated to reflect clearer instructions for billing with radiological procedures. Effective 08/01/2019. |
08/07/2019 | Interpreter Services | Chapter 14 has been updated to clarify L&I strongly discourages the use of family members as interpreters. Effective 08/01/2019. |
07/01/2019 | Evaluation and Management Services | The following language should have appeared in Chapter 10: Evaluation and Management (E/M) Services, Services That Aren't Covered: Includes telehealth with home as an origination site. This was accidentally omitted in the 2019 posting. |
Fee schedule updates
Posting date | Description | Updated Version |
---|---|---|
08/20/2020 | Effective August 18, 2020, CPT code 64590 is covered per L&I's Professional Fee Schedule. The Non Facility maximum fee is $506.27 and the Facility maximum fee is $304.28. | N/A |
08/20/2020 | Effective August 18, 2020, CPT code 64590 is covered per L&I's Ambulatory Surgery Center Fee Schedule. The maximum fee is $38,936.49. | N/A |
08/19/2020 | The following procedure codes are not covered effective 09/19/2020:
|
N/A |
06/03/2020 | New July procedure codes. Effective July 1, 2020. | New July 2020 codes |
05/07/2020 | The following codes have been added to the fee schedule and are billable for dates of service on or after 04/14/2020:
|
N/A |
04/08/2020 | CPT code 87635 is covered effective 04/01/2020. It is billable for dates of service on or after 02/04/2020 and has a maximum fee of $51.31. | |
03/18/2020 | New HCPCS Codes Effective April 1, 2020 and Deleted HCPCS Codes as of March 31, 2020. This includes two new codes for coronavirus testing. | New and Deleted HCPCS April 2020 |
12/31/19 | Effective January 1, 2020 the Progressive Goal Attainment Program (PGAP®) billing codes of 96150, 96151 and 96152 (listed in the Department’s Payment Policies Chapter 22: Other Services) will be replaced with billing codes 1400W, 1401W and 1402W. | PGAP® billing code updates |
12/19/2019 | Effective January 1, 2020 procedure code 27447 is covered in ASC facilities with a maximum fee of $18,108.12. 27447 is subject to multiple procedure discounting. | N/A |
12/13/2019 | Ambulatory Surgery Center Fee Schedule Updates: New codes effective January 1, 2020 and deleted codes effective December 31, 2019 | New ASC codes effective January 1, 2020 and deleted codes effective December 31, 2019 |
12/11/2019 | Professional Fee Schedule Updates: New CPT and HCPCS effective January 1, 2020 | New CPT & HCPCS effective January 1, 2020 |
12/10/2019 | DELETED Procedure Codes for 2020 effective 12/31/2019 | Deleted Codes January 2020 |
11/6/2019 | Effective 12/15/2019 90868 has a maximum fee of $411.03. | N/A |
09/26/2019 | ADDED Procedure Codes for October Updates | Added Codes October 2019 |
09/26/19 | DELETED Procedure Codes for October Updates | Deleted Codes October 2019 |
09/26/19 | Effective 10/01/2019 Q0162 Ondansetron oral is covered with a maximum fee of $0.06. | N/A |
08/07/19 | E0761 is considered experimental and investigational and not covered effective 09/01/19. | N/A |
Corrections
Payment policy corrections
Posting date | Policy Area | Description |
---|---|---|
04/14/2020 | All Temporary Telehealth Policies | When telehealth services are provided to a worker when they are at home (home is the originating site), providers should bill with place of service –12. |
10/18/2019 | Chapter 27: Reports and Forms | An error occurred in the payment policy, the maximum fee for S9982 is $0.54. |
Fee schedule corrections
Posting date | Description | Updated Version |
---|---|---|
08/19/2020 | Codes G0480-G0483 now require prior authorization, effective 09/19/2020. | N/A |
05/07/2020 | The following code should have appeared on the 2019 fee schedule with corresponding value:
|
N/A |
1/10/2020 | The following codes should have appeared on the 2019 fee schedule with corresponding values:
|
N/A |
08/30/2019 | An error was found on the fee schedule. The correct fee for 90371 is $181.14. | |
08/07/2019 | An error was published on the 2019 fee schedule. The correct values are as follows:
|
07/01/19 |
Temporary Telehealth Payment Policies
Posting date | Policy Area | Description |
---|---|---|
4/10/2020 | Temporary Telehealth IME and Record Review Policy | To help support containment of the COVID-19 outbreak, the Temporary IME and Record Review policy allows temporary coverage for independent medical examiners to complete exams via telehealth. This policy is effective 3/9/2020 and expires 06/30/2022. This is an emerging situation, and this policy may be updated as needed. |
4/10/2020 | Temporary Telehealth Policy for Activity Prescription Forms (APFs) | To help support containment of the COVID-19 outbreak, the Temporary Telehealth Policy for Activity Prescription Forms (APFs) allows temporary coverage for providers to complete APFs via telehealth. This policy is effective 3/9/2020 and expires 03/31/2022. This is an emerging situation, and this policy may be updated as needed. |
4/10/2020 | Temporary Telehealth for Initial Evaluation policy | To help support containment of the COVID-19 outbreak, the Temporary Telehealth Policy for Initial Evaluation allows the temporary coverage of new patient evaluation and management services. This policy is effective 3/9/2020 and expires 03/31/2022. This is an emerging situation, and this policy may be updated as needed. |
4/6/2020 | Temporary TeleBrain Rehab policy | To help support containment of the COVID-19 outbreak, the Temporary TeleBrainRehab Payment Policy allows the temporary coverage of telehealth for outpatient brain injury rehabilitation services. This policy is effective 3/9/2020 and expires 03/31/2022. This is an emerging situation, and this policy may be updated as needed. |
4/3/2020 | Temporary Interpreter Services via Video or Telephone Policy | To help support containment of the COVID-19 outbreak, the Temporary Interpretive Services via Video or Telephone Policy allows interpreters to provide service either by video or by telephone. This policy is effective 3/9/2020 and expires 6/30/2021. This is an emerging situation, and this policy may be updated as needed. |
3/9/2020 | Temporary Telerehab Work Hardening Policy | To help support containment of the COVID-19 outbreak, the Temporary Telerehab Work Hardening payment policy allows providers to use the worker’s home as an origination site for treatment following the initial in person evaluation. This policy is effective 4/01/2020, and expires 03/31/2022. This is an emerging situation, and this policy may be updated as needed. |
3/25/2020 | Temporary TeleSIMP Policy | To help support containment of the COVID-19 outbreak, the temporary teleSIMP policy allows medical providers to use home as an origination site in some instances to treat injured workers. This policy is effective 3/9/2020, and expires 03/31/2022. This is an emerging situation, and this policy may be updated as needed. |
3/20/2020 | Temporary Telerehab policy | To help support containment of the COVID-19 outbreak, the temporary telerehab policy allows physical therapists, occupational therapists, and speech language pathologists to use telehealth as a modality to deliver services to established patients in outpatient settings. This policy is effective March 9, 2020 and expires 03/31/2022. |
3/16/2020 | Temporary Telehealth Policy | To help support containment of the COVID-19 outbreak, the temporary telehealth policy allows medical providers to use home as an origination site in some instances to treat injured workers. This policy is effective 3/9/2020, and expires 03/31/2022. This is an emerging situation, and this policy may be updated as needed. |