2023 Fee Schedules
Effective July 1, 2023
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.
2023 Quick Reference Fee Schedule (English) Español (Spanish) - Coming Soon!
Professional and Facility Services Fee Schedules (July 2023)
Note: These fee schedules have been enhanced with search features for your convenience. Enable Macros in Excel for the files below to open without errors. These files are best viewed in the desktop application and not the web browser.
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
Anesthesia — CPT™ 00100 - 01999ASC Fee Schedules — All approved codesAPR-DRG Assignment — Version 38Hospital 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
2023 Billing & Payment Policies
Effective July 1, 2023
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.
- 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 -
Language Access 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 and Acupuncture Services - 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.
2023 Updates and Corrections
Updates
Payment policy updates
Posting date | Policy Area | Description |
---|---|---|
09/15/2023 | Chapter 17: Mental Health Services | Transcranial magnetic stimulation is limited to 30 sessions per authorized course of treatment. See our Chapter 17 Update for details. Effective October 15, 2023. |
08/15/2023 | Chapter 2: Information for all Providers | The incorrect form number was linked for the General Provider Billing Manual. Providers should reference form F245-432-000. |
08/15/2023 | Chapter 10: Evaluation and Management [E/M] services | For additional documentation guidelines and requirements regarding new and established outpatient office visits and prolonged services, providers should reference the 2021 AMA E/M guideline updates. The 2023 AMA E/M guideline updates are still applicable to all other types of E/M visits. |
08/09/2023 | Chapter 2: Information for All Providers | Groups or facilities, agencies, organizations or institutions must have a Federal Tax Identification Number before submitting an application in ProviderOne. |
08/08/2023 | Chapter 13: Independent Medical Exams | We are updating |
Fee schedule updates
Posting date |
Description | Updated Version |
---|---|---|
09/26/2023 | New HCPCS and Deleted HCPCS codes. See file for details. | New and Deleted HCPCS October 2023 |
09/15/2023 | Effective October 1, 2023, J9041 requires prior authorization. | N/A |
7/18/2023 | Effective July 1, 2023, 90739 is covered with conditions. This is for for post exposure prophylaxis use only. Prior authorization is required. This code pays "By Report". | N/A |
6/15/2023 | Effective May 11, 2023 C9803 is deleted. | N/A |
6/15/2023 | New HCPCS and deleted HCPCS codes | |
Corrections
Payment policy corrections
Posting date | Policy Area | Description |
---|---|---|
08/03/2023 | Chapter 23: Pathology and Laboratory Services | Page 13 of Chapter 23: Pathology and Laboratory Services incorrectly lists the fee for 2 automated tests that are components of 80061. The correct automated test maximum fee for 2 tests performed as part of panel 80061 is $11.15. The correct maximum payment for the example listed is $22.78. Effective July 1, 2023. |
Fee schedule corrections
Posting date | Description | Updated Version |
---|---|---|
09/15/2023 | An error has been identified in the Professional Services Fee Schedule. Code 76496 isn't covered. Effective September 15, 2023. | N/A |
08/02/2023 | An error has been identified in the Professional Services Fee Schedule. The following codes should have appeared on the 2023 fee schedule with these corresponding values. These fees are effective July 1, 2023. |
N/A |
08/01/2023 | We've identified an error in the Local Codes Listed By Specialty Fee Schedule. Case Management codes 1292M-1299M are erroneously included. These codes are not in effect and are not billable. The correct Case Management codes are 1220M-1225M. Effective July 1, 2023. | N/A |
07/24/2023 | We've identified an error in the Professional Services Fee Schedule. Code 8902H requires prior authorization. | N/A |
07/10/2023 | An error has been identified in the Professional Services Fee Schedule. The following codes aren't active: A9599, C9055, C9140, C9485, C9486, J9199. This is effective June 30, 2023. | N/A |
07/06/2023 | An error has been identified in the Professional Services Fee Schedule. Code 8901H should appear with a rate of $15.74. This is effective July 1, 2023. | N/A |
Temporary Telehealth Payment Policies
Posting date | Policy Area | Description |
---|---|---|
12/01/2022 | Temporary IME Telehealth Policy | The |