Fee Schedules

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                                                           

Fee Schedules - Comma delimited version with Field Key

Billing & Payment Policies

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.

Payment Policies Complete  (2023)

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

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 Chapter 13: Independent Medical Exams​​ to include telehealth services.

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 July 2023 Adds and Deletes​

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. 
  • 80047  $13.66
  • 80048  $13.66
  • 80050  $48.55
  • 80051  $13.66
  • 80053  $18.25
  • 80055  $88.22
  • 80061  $22.78
  • 80069  $13.66
  • 80074  $67.63
  • 80076  $13.66
    		•  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 Policies

    Temporary Telehealth Payment Policies

    Posting date Policy Area Description
    12/01/2022 Temporary IME Telehealth Policy The Temporary IME Telehealth Policy​ ​allows independent medical examiners to complete exams via telehealth. This policy became effective January 1, 2023 and expires on August 31, 2023. This is an emerging situation, so this policy may be updated as needed. ​