Policy 2019

Fee Schedules

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.

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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

Billing & Payment Policies

2019 Billing & Payment Policies

Effective July 1, 2019

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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.

Updates & Corrections

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: 80299 83992 G6040 G6042 G6056	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: C9803 is a Facility Only code with a maximum fee of $25.00 86328 & 86769 which both have a maximum fee of $19.35. U0003 & U0004 which both have a maximum fee of $100.00	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: 00731 - Anesthesia Base 5 00732 - Anesthesia Base 6	N/A
1/10/2020	The following codes should have appeared on the 2019 fee schedule with corresponding values: Code 00811 - Anesthesia Base 4 Code 00812 - Anesthesia Base 3 Code 00813 - Anesthesia Base 5 These codes have been effective since 1/1/2018.	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: 96136 - Non-Facility Fee $88.69, Facility Fee $45.97 96137 - Non-Facility Fee $82.22, Facility Fee $35.61	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.