2025 Fee Schedules
Effective July 1, 2025
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.
2025 Quick Reference Fee Schedule (English) Español (Spanish)
Professional and Facility Services Fee Schedules (July 2025)
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.
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- Evaluation and Management — CPT® 98000 - 98016 and 99202 - 99499
- Surgery — CPT® 10004 - 69990
- Radiology — CPT® 70010 - 79999
- Pathology and Laboratory — CPT® 80047 - 89398 and 0001U - 0216U
- Medicine — CPT® 90281 - 99607
- CPT® Category II and III — CPT® 0001F - 0566T
- HCPCS — A0021 - V5364
- Medical and Surgical Supplies Codes — HCPCS A4206 - A9999 (For DME Providers)
- Facility Only Codes — C1605 - Q5133
- Local Codes —Local Codes Listed by Specialty
- Anesthesia — CPT® 00100 - 01999
- ASC Fee Schedules — All approved codes
- APR-DRG Assignment — Version 38
- Hospital Rates
- Skilled Nursing and Residential Care 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
2025 Billing & Payment Policies
Effective July 1, 2025
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 (2025)
| Chapter Title | Topics |
|---|---|
| Introduction | |
| General provider information, billing, chart notes, roles and responsibilities | |
| General information for Attending Providers, details for specific providers (such as chiropractors and naturopaths), consultations, 1044M | |
| Audiology, hearing aids | |
| Nurse case management, phone calls, online communications, team conferences, health services coordination | |
| Dental services | |
| Medical equipment, supplies | |
| Imaging, EKG, biofeedback | |
| Evaluation and management services, separately billable services | |
| Modifications to homes, vehicles | |
| Impairment ratings and IMEs | |
| Injections, infusions, acupuncture, dry needling | |
| Immunizations, pathology, laboratory services | |
| Spoken language interpretation services | |
| Lodging, taxi, ambulance, travel reimbursement | |
| Medical testimony | |
| Mental health evaluation, treatment, behavioral health interventions, PGAP | |
| Obesity, sign language, document translation services, best practice provider incentives, worker reimbursement | |
| Opioids, medications and drugs | |
| Physical therapy, occupational therapy, massage, chiropractic care | |
| Commonly billable reports and forms | |
| RBRVS | |
| Surgical care | |
| Telehealth, remote services, and mobile clinics | |
| Vocational services | |
| Hospitals, ambulatory surgical centers | |
| Brain injury programs (BIRP), structured intensive multidisciplinary program (SIMP), residential treatment facilities | |
| Skilled nursing, adult family homes, assisted living, home health care | |
| Terms used in MARFS | |
| Modifiers used in MARFS | |
| POS codes used in the workers compensation system | |
2025 Updates and Corrections
Updates
| Posting date | Policy Area | Description |
|---|---|---|
| 12/01/2025 | Chapter 21: Reports and Forms | 1038M is limited to 1 unit per day of service and must be billed before 1028M. Effective January 1, 2026, 1028M is limited to 8 units per day of service. Independent Medical Examiners (IMEs) are exempt from these requirements. |
| 12/01/2025 | Chapter 20: Physical Medicine | |
| 09/01/2025 | Chapter 25: Vocational Services | Updates have been made to the basic skill enhancement training portion of |
| 08/21/2025 | Chapter 5: Care Coordination | Providers may bill for online communications (9918M) with Health Services Coordinators (HSCs) as long as the communication is clinical in nature and meets all other service and documentation guidelines. HSCs have been added to the covered participant list effective July 1, 2025. |
| 07/17/2025 | Chapter 23: Surgery | When billing for implants (such as artificial discs, grown cells, and so on), the surgical facility associated with the procedure must bill using HCPCS codes. The insurer's relationship is to the surgical facility, not the third party providing the materials. Third parties providing implants may not bill the insurer directly and must work with the surgical facility for payment. Effective July 1, 2025. |
| 07/17/2025 | Chapter 19: Pharmacy | Pharmacy billing is limited to NDCs through either MPOS or by paper bill. Pharmacies can’t bill or be paid for CPT® or HCPCS Level II codes, except S9445. When billing S9445, pharmacies must submit a paper bill. Effective July 1, 2025. |
| 06/15/2025 | Chapter 5: Care Coordination | Significant updates have been made to Case Management Telephone Calls, effective July 1, 2025. In addition to the updated policy in Chapter 5: Care Coordination, L&I has also developed a frequently asked questions resource ( |
| Posting date | Description | Updated Version | |
|---|---|---|---|
| 01/12/2026 | Effective January 1, 2026, the reimbursement for privately-owned vehicles (POV) mileage is $0.73/mile. | N/A | |
| 01/05/2026 | Upon further review, the following January added codes aren't covered effective January 1, 2026.
|
Please refer to |
|
| 12/16/2025 | Several codes in the January add file were missing their -TC/-26 pricing. The Excel file reflects the new codes with their modifier pricing for the covered codes only. | Updated Version: January 2026 PCTC Pricing | |
| 12/11/2025 | ASC Added and Deleted Codes. Effective January 1, 2026. | January 2026 ASC Added and Deleted Codes | |
| 12/11/2025 | New CPT and HCPCS codes. Effective January 1, 2026. | January 2026 Added Codes | |
| 12/11/2025 | Deleted CPT and HCPCS codes. Effective December 31, 2025. | January 2026 Deleted Codes | |
| 09/22/2025 | New HCPCS and Deleted HCPCs. See file for details. In addition, the following codes are removed from the ASC fee schedule as of 9/20/2025:
|
||
| 06/24/2025 | Effective July 1, 2025, 20999 requires authorization through utilization review. | N/A |
Corrections
| Posting date | Policy Area | Description |
| 11/25/2025 | Chapter 19: Pharmacy | Page 4 of Chapter 19: Pharmacy incorrectly links to Chapter 16: Medical Testimony. It should link to |
| 11/25/2025 | Chapter 12: Injection and Medication Administration | An error was identified in Chapter 12: Injections and Medication Administration. |
| 11/19/2025 | Chapter 3: Attending Providers | Page 24 of Chapter 3: Attending Providers incorrectly linked to Chapter 23: Surgery. It should have linked to Chapter 24: Telehealth, Remote and Mobile Services. |
| 07/07/2025 | Chapter 17: Mental Health and Behavioral Health Interventions. | We are clarifying that BHI is limited to 1 hour (1 unit of 96158 and 2 units of 96159) per day, per worker. This limit doesn't impact the total visit count for BHI, which is still 16 visits. Effective July 1, 2025. |
| Posting date | Description | Updated Version |
|---|---|---|
| 01/05/2026 | An error has been identified in the CPT and HCPCS deleted codes file for January 1, 2026. J1572 isn't terminating for the Professional Fee Schedule as of December 31, 2025. Please refer to the Professional Fee Schedule for pricing. For Ambulatory Surgery Centers, J1572 remains terminated as of December 31, 2025. | N/A |
| 12/16/2025 | We've identified an error in the Professional Services Fee Schedule. Codes Q2053 and Q2054 should have appeared as non-covered. Effective December 31, 2025. | N/A |
| 08/15/2025 | We've identified an error in the Professional Services Fee Schedule. Code 75574 should have appeared with a -26 value of $200.65 and a -TC value of $405.98. Effective July 1, 2025. | N/A |
| 07/08/2025 | We've identified an error in the Professional Services Fee Schedule. 25447, 25448, and 25449 should have appeared as requiring prior authorization through Utilization Review. Effective July 1, 2025. | N/A |
| 07/03/2025 | We've identified an error on the Professional Services Fee Schedule. R0398 should have appeared with a rate of $10.65. Effective July 1, 2025. | N/A |
| 06/16/2025 | We've identified an error on the Professional Services Fee Schedule. G9001 shouldn't have appeared as a covered code. Effective July 1, 2025. | N/A |
| 06/09/2025 | We've identified an error in the professional services fee schedule. |
N/A |
| 06/09/2025 | We've identified an error in the local codes listed by specialty file. 1154M should have appeared with a value of $73.50 for both facility and non-facility. This is effective July 1, 2025. | N/A |
| 06/06/2025 | We've identified an error in the Professional Services Fee Schedule. The following codes should have appeared with a fee of $0.00 and an FSI of B for bundled effective July 1, 2025:
|
N/A |