Fee Schedules

2021 Fee Schedules

Effective July 1, 2021

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.

2021 Quick Reference Fee Schedule 

Professional and Facility Services Fee Schedules (July 2021)

Note: These fee schedules have been enhanced with search features for your convenience.

  • Professional Services Fee Schedule — Excel spreadsheet of the complete fee schedule excluding the ASC Fees, AP-DRGs, Hospital Rates and Residential Facility Rates. This fee schedule has been enhanced with a search feature for your convenience.

Note: For your reference here are the code ranges you will find in the professional fee schedule. 

    • Evaluation and Management — CPT™ 99202 - 99499
    • Surgery — CPT™ 10004 - 69979
    • Radiology — CPT™ 70010 - 79999
    • Pathology and Laboratory — CPT™ 80047 - 89398 and 0001U - 0222U
    • Medicine — CPT™ 90281 - 99607
    • CPT ™ Category II and III — CPT™ 0001F - 0639T
    • HCPCS — HCPCS A0021 - V5364
    • Medical and Surgical Supplies Codes — HCPCS A4206 - A9999
      (For DME Providers)
    • Facility Only Codes — C1300 - S0093
    • Local Codes — Local Codes Listed by Specialty                                                           

Fee Schedules - Comma delimited version with Field Key

Billing & Payment Policies

2021 Billing & Payment Policies

Effective July 1, 2021

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 (2021)

Professional Services

Facility 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

2021 Updates and Corrections

Updates

Payment policy updates

Posting date Policy Area Description
02/01/2022 As applicable Several policy updates for telehealth coverage are now available.
Each policy is effective March 4, 2022​.
  • Chapter 7: Chiropractic Services
  • Chapter 10: Evaluation and Management Services
  • Chapter 17: Mental Health Services
  • Chapter 19: Naturopathic Physicians
  • Chapter 22: Other Services
  • Chapter 25: Physical Medicine Services
  • Chapter 33: Brain Injury Rehabilitation Services
  • Chapter 34: Chronic Pain Management
    		•
    01/03/2022 Chapter 17: Mental Health Services A policy update regarding rTMS​ is now available. Effective February 1, 2022. ​
    11/30/2021 Chapter 20: Nurse Case Management A policy update regarding NPI requirements for NCMs​ is now available. Effective January 1, 2022.
    11/30/2021 Chapter 25: Physical Medicine Services A policy update that clarifies authorization and reporting requirements for massage therapists​ is now available. Effective January 1, 2022.
    11/30/2021 Chapter 10: Evaluation and Management  Services Medicare made changes to their E/M shared billing policy. L&I has not allowed shared billing of E/M in the past and will continue to not allow shared billing in the future.
    10/22/2021 As applicable A policy regarding students and student supervision​ is now available. Effective October 25, 2021.
    09/13/2021 As applicable Certain chapters may incorrectly link to the old general provider billing manual. A new version of the General Provider Billing Manual​ is now available. Effective September 13, 2021.​
    07/30/2021 Language Access Services 9976M is available for tactile sign interpretation, retroactive to July 1, 2018. Payable only to tactile interpreters for the total cost of services rendered.

    Mileage isn't a covered service for tactile interpreters per updated policy effective October 1, 2020.​
    06/18/2021 As applicable Certain chapters may incorrectly list CPT code 99201 as an active code. Effective July 1, 2021, this code is no longer covered.​

    Fee schedule updates

    Posting date

    		 Description Updated Version
    03/17/2022 New HCPCS effective April 1, 2022.
    Deleted HCPCS effective March 31, 2022.    		 Professional Fee Schedule Adds and Deletes​
    02/23/2022 Effective December 23, 2021, J0248 is covered with prior authorization for outpatient settings only. The maximum facility-only fee is $561.60. N/A
    02/23/2022 Effective August 16, 2021, 90671 is covered with prior authorization. The maximum fee is $221.80. N/A
    02/18/2022 Effective February 1, 2022, the following codes have updated maximum fees. These apply to facility and non-facility fees: 
  • 90867  $539.58
  • 90869  $474.83
    		•  N/A
    02/16/2022 Effective December 28, 2021, C9507 is covered in outpatient settings. The maximum facility-only fee is $750.50. N/A
    01/18/2022 Effective January 1, 2022, the reimbursement rate for privately-owned vehicle (POV) mileage is increased to $0.59/mile. N/A
    12/21/2021 ASC updates: Added and deleted CPT and HCPCS codes effective January 1​, 2022. January 2022 ASC Adds and Deleted codes​
    12/21/2021 New anesthesia codes effective January 1, 2022.​ January 2022 Anesthesia adds​​
    12/21/2021 Deleted CPT and HCPCS codes effective December 31, 2021. ​ January 2022 Deleted codes​​
    12/21/2021 New CPT and HCPCS codes effective January 1, 2022.​ January 2022 Added codes​
    10/26/2021 The Department is allowing coverage of the COVID-19 booster vaccine for immunocompromised workers who reside in a nursing home, group home, or skilled nursing facility, or are receiving home health at home. Prior authorization required.
    91306 effective 10/20/2021 $0.01
    0064A effective 10/20/2021 $40.00    		 N/A
    09/29/2021​ We are in the process of installing APC Grouping software for 2021. Outpatient bill adjustments will occur once the software update is complete. N/A
    09/29/2021 New HCPCS effective October 1, 2021.
    Deleted HCPCS codes effective September 30, 2021.    		 New and Deleted HCPCS October 2021​
    09/29/2021 The Department is allowing coverage of the COVID-19 booster vaccine for immunocompromised workers who reside in a nursing home, group home, or skilled nursing facility, or are receiving home health at home. Prior authorization required.​
    0004A effective 9/22/2021 $40.00​    		 N/A
    09/08/2021 The following COVID-19 related codes have been updated. Prior authorization is no longer required for patients who are in an outpatient setting (type of service X) for the following codes: 
  • M0243 - effective 5/6/21
  • M0245 - effective 4/1/21
  • M0247 - effective 5/26/21
  • M0249 - effective 6/24/21
  • M0250 - effective 6/24/21
    		•  N/A
    09/08/2021 The Department is allowing the coverage of the COVID-19 vaccine for immunocompromised workers who reside in a nursing home, group home, or skilled nursing facility, or are receiving home health are home. Prior authorization is required, except for M0240 when performed in an outpatient setting. 
  • Q0240 - effective 7/30/2021 - $0.00
  • M0240 - effective 7/30/2021 - $450.00
  • M0241 - effective 7/30/2021 - $750.00
  • 0013A - effective 8/12/2021 - $40.00 
  • 0003A - effective 8/12/2021 - $40.00
    		•  N/A
    06/24/2021 New HCPCS and Deleted HCPCS codes. See file for effective dates.​ New and Deleted HCPCS July 2021​​

    Corrections

    Payment policy corrections

    Posting date Policy Area Description
    12/17/2021 Chapter 10: Evaluation and Management Services​ Page 16 of Chapter 10: Evaluation and Management Services incorrectly excludes employers from the list of attendees providers may meet with as part of team conferences. This correction is retroactive to July 1, 2021.
    The section should read as follows: 

    Team conferences may be payable when the current or former attending providers, consultants, or concurrent care providers meets with one or more of the following:
    An interdisciplinary team of health professionals, such as: 
  • Vocational rehabilitation counselors, or 
  • Nurse case managers, or 
  • PTs, OTs, and speech language pathologists, or Psychologists. 
  • L&I staff,  or 
  • L&I medical consultants, or 
  • SIEs/TPAs, or Employers.​
    		•
    12/16/2021 Chapter 9: Durable Medical Equipment (DME) & Chapter 28: Supplies, Materials, and Bundled Services Language has been added to clarify the Department's position on pneumatic compression devices: Pneumatic compression devices used during surgery and sent home with the worker are considered surgical supplies. The cost of the device is bundled into the surgical service fee and is not separately payable, even to DME suppliers.​
    09/29/2021 Chapter 17: Mental Health Services​ Page 6 of Chapter 17: Mental Health Services links to the Authorization and Reporting Requirements for Mental Health Specialists. This form will undergo updates in the near future. For the most up to date form and information- visit our Mental Health Services page. In addition- on page 3 of the same policy- RCW 51.08.142 should also be referenced in addition to WAC 296-21-270 and 296-14-300.​
    08/11/2021 Chapter 23: Pathology and Laboratory Services Page 8 of Chapter 23: Pathology and Laboratory Services incorrectly lists G6058 -Drug confirmation- each procedure- as a covered service for drug screening. This is a non-covered code. This section should read as follows: The department will pay for drug screening using the following billing codes: For presumptive testing billing codes 80305- 80306- or 80307- or For definitive testing HCPCS codes G0480- G0481- G0482- or G0483. G0480-G0483 requires prior authorization. ​
    06/18/2021 Chapter 17: Mental Health Services Page 10 of Chapter 17: Mental Health Services incorrectly lists only 90837 as billable with CPT codes 99354, 99355, 99356, and 99357. The statement should read as follows: Use the appropriate prolonged services codes (99354, 99355, 99356, 99357) with either 90837 for psychotherapy or 90847 for family psychotherapy, for face to face services with the patient, not performed with E/M services. See Chapter 10: Evaluation and Management (E/M) Services for additional details on prolonged services.​

    Fee schedule corrections

     Posting date Description Updated Version
    01/02/2024 We’ve identified an error in the Low Outlier Threshold amounts for APR-DRGs 055 and 056. Effective: July 1, 2021​. The following values should have appeared on the 2021/2022/2023 fee schedules starting July 1 of each year, with the corresponding DRG/SOI combinations:

    DRG 055
    SOI 1 - $1,164.92
    SOI 2 - $1,708.35
    SOI 3 – $2,523.86
    SOI 4 - $4,650.78 

    DRG 056
    SOI 1 - $788.16
    SOI 2 - $1,598.11
    SOI 3 – $2,651.11
    SOI 4 - $4,438.67     		 N/A
    03/24/2022 An error has been identified in the Professional Services Fee Schedule​. CPT code 64585 was incorrectly listed as requiring utilization review (UR) for prior authorization. It requires claim manager (CM) authorization, not UR. N/A
    02/08/2022 An error has been identified in the Professional Services Fee Schedule. CPT codes 99421-99422 and 99423 are non-covered procedures.​ N/A
    08/26/2021 An error has been identified in the Professional Services Fee Schedule. The following codes should have appeared on the 2021 fee schedule with prior authorization required through the claim manager:
    • 1045M
    • 1098M
    		 N/A
    08/16/2021 An error has been identified in the Professional Services Fee Schedule. The following codes should have appeared on the 2021 fee schedule with corresponding values: 
  • E0660-NU $189.69
  • E0665-NU $150.61
  • E0666-NU $163.97
  • E0667-NU $384.43
    		•  N/A
    08/03/2021 Fees for pharmacy and DME suppliers are available in the excel file titled Medical and Surgical Supply Codes. Per chapter 9- these providers may receive reimbursement for these codes because they're not bundled into a service. These fees are effective July 1, 2021. ​ Medical and Surgical Supply Codes​​
    07/19/2021 The following COVID-19 related codes have been updated. The Department is allowing the coverage of the COVID-19 vaccine for immunocompromised workers who reside in a nursing home- group home- skilled nursing facility- or are receiving home health are home. Prior authorization is required. The Department has updated its fees for the following codes: 
  • M0245-effective 4/1/2021- $450.00
  • Q0244-effective 6/3/2021- $0.00 
    		•  N/A
    07/12/2021 An error has been identified in the Professional Services Fee Schedule. 1158M should have appeared with prior authorization Y-CM. This code is covered effective 07/01/2021.​ N/A
    07/06/2021 An error has been identified in the Professional Services Fee Schedule. 99417 should have appeared as fee schedule indicator R- not X. This code is covered effective 07/01/2021​. N/A
    06/28/2021 An error has been identified on the Anesthesia fee schedule. The following codes should have appeared on the 2021 Anesthesia fee schedule with corresponding values:
    • 00731 - Anesthesia Base 5
    • 00732 - Anesthesia Base 6
    • 00811 - Anesthesia Base 4
    • 00812 - Anesthesia Base 3
    • 00813 - Anesthesia Base 5
    These codes became effective January 1, 2018.    		 N/A
    06/28/2021 An error has been identified in the Professional Services Fee Schedule.  0001A is priced at $40.00 effective March 15, 2021. ​ N/A
    06/28/2021 Effective Date 07/01/2021
    Revised and Corrected APR DRG v38 Assignment Sheets    		 APR DRG Assignment CSV 2021 Cover and Key​
    APR DRG Assignment CSV 2021 REVISED​
    APR DRG Assignment Excel 2021 REVISED​

    Temporary Telehealth Payment Policies

    Temporary Telehealth Payment Policies

    Posting date Policy Area Description
    02/02/2022 Temporary Telehealth Services The temporary telehealth policies will expire March 3, 2022. The Independent Medical Exam temporary telehealth policy remains in effect through June 30, 2022. The permanent telehealth policies will be effective March 4, 2022. See the updates and corrections tab for details.​
    2/12/2021 Temporary Telehealth Services Description: Acute care hospitals may bill Q3014 on a UB-04 form when the patient is a registered outpatient- and staff are supporting the professional telehealth service. In this case- the acute care hospital may bill the originating site facility fee Q3014. Use G0463 if the patient and the practitioner are both located within the acute care hospital during a telehealth visit. This update aligns with L&I’s temporary payment policies effective March 9, 2020 and will expire March 3, 2022 unless the Department determines an extension is appropriate.
    2/26/2021 Temporary Policy for Services Provided by Audio Only When services are provided by telephone- bill multiple units as appropriate. For calls exceeding 30 minutes- multiple units of 99441-99443 or 98966-98968 may be billed. For example- if the duration of the call is 60 minutes- bill 2 units of 99443 or 98968. Use other time based codes as defined by their minutes to add to time beyond 99441 or 98966. Documentation should support why the visit occurred by phone instead of telehealth or in person- and contain the same elements as defined in the temporary telehealth policies- such as worker consent for the visit to occur by phone. For additional telephone call requirements- see Chapter 10: Evaluation and Management. This is retroactive to March 9, 2020.
    12/7/2020 Temporary Telehealth Policy for Naturopaths To help support containment of the COVID-19 outbreak- the Temporary Telehealth Policy for Naturopaths allows temporary coverage for naturopath exams via telehealth. This policy is effective 3/9/2020 and expires 03/03/2022​. This policy is superseded by a permanent policy, please see updates and corrections.​
    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 03/03/2022​​. This policy is superseded by a permanent policy, please see updates and corrections.​​
    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 03/03/2022​​. This policy is superseded by a permanent policy, please see updates and corrections.​​
    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 03/03/2022​​. This policy is superseded by a permanent policy, please see updates and corrections.​​
    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​​.​
    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 03/03/2022​​. This policy is superseded by a permanent policy, please see updates and corrections.​​
    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 03/03/2022​​. This​ policy is superseded by a permanent policy, please see updates and corrections.​​
    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 03/03/2022​​. This​ policy is superseded by a permanent policy, please see updates and corrections.​​
    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 policy is superseded by a permanent policy, please see updates and corrections.​​