Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-550 - Hospital services › Section 182-550-1500 - Covered and noncovered revenue code categories and subcategories for outpatient hospital services

Current through Register Vol. 24-14, July 15, 2024
(1) The medicaid
				agency pays for an outpatient hospital covered service in the following revenue
				code categories and subcategories when the hospital provider accurately bills:
(a) "Pharmacy," only subcategories "general
				classification," "generic drugs," "nongeneric drugs," "drugs incident to other
				diagnostic services," "drugs incident to radiology," "nonprescription," and "IV
				solutions";
(b) "IV therapy," only
				subcategories "general classification," "infusion pump," "IV therapy/pharmacy
				services," "IV therapy/drug/supply delivery," and "IV
				therapy/supplies";
(c)
				"Medical/surgical supplies and devices," only subcategories "general
				classification," "nonsterile supply," "sterile supply," "pacemaker,"
				"intraocular lens," and "other implant," and "other
				supplies/devices";
(d) "Oncology,"
				only subcategory "general classification";
(e) "Durable medical equipment (other than
				renal)," only subcategory "general classification";
(f) "Laboratory," only subcategories "general
				classification," "chemistry," "immunology," "renal patient (home)," "nonroutine
				dialysis," "hematology," "bacteriology and microbiology," and
				"urology";
(g) "Laboratory
				pathology," only subcategories "general classification," "cytology,"
				"histology," and "biopsy";
(h)
				"Radiology - Diagnostic," only subcategories "general classification,"
				"angiocardiography," "arthrography," "arteriography," and "chest
				X-ray";
(i) "Radiology -
				Therapeutic and/or chemotherapy administration," only subcategories "general
				classification," "chemotherapy - injected," "chemotherapy - oral," "radiation
				therapy," and "chemotherapy -IV";
(j) "Nuclear medicine," only subcategories
				"general classification," "diagnostic," and "therapeutic," "diagnostic
				radiopharmaceuticals," and "therapeutic radiopharmaceuticals";
(k) "CT scan," only subcategories "general
				classification," "head scan," and "body scan";
(l) "Operating room services," only
				subcategories "general classification" and "minor surgery";
(m) "Anesthesia," only subcategories "general
				classification," "anesthesia incident to radiology," and "anesthesia incident
				to other diagnostic services";
(n)
				"Administration, processing and storage for blood and blood components," only
				subcategories "general classification" and "administration";
(o) "Other imaging," only subcategories
				"general classification," "diagnostic mammography," "ultrasound," "screening
				mammography," and "positron emission tomography";
(p) "Respiratory services," only
				subcategories "general classification," "inhalation services," and "hyperbaric
				oxygen therapy";
(q) "Physical
				therapy," only subcategories "general classification," "visit charge," "hourly
				charge," "group rate," and "evaluation or reevaluation";
(r) "Occupational therapy," only
				subcategories "general classification," "visit charge," "hourly charge," "group
				rate," and "evaluation or reevaluation";
(s) "Speech therapy - Language pathology,"
				only subcategories "general classification," "visit charge," "hourly charge,"
				"group rate," and "evaluation or reevaluation";
(t) "Emergency room," only subcategories
				"general classification" and "urgent care";
(u) "Pulmonary function," only subcategory
				"general classification";
(v)
				"Audiology," only subcategories "general classification," "diagnostic," and
				"treatment";
(w) "Cardiology," only
				subcategories "general classification," "cardiac cath lab," "stress test," and
				"echocardiology";
(x) "Ambulatory
				surgical care," only subcategory "general classification";
(y) "Magnetic resonance technology (MRT),"
				only subcategories "general classification," "MRI - Brain (including
				brainstem)," "MRI - Spinal cord (including spine)," "MRI-other," "MRA - Head
				and neck," "MRA - Lower extremities" and "MRA-other";
(z) "Medical/surgical supplies - Extension,"
				only subcategories "supplies incident to radiology," "supplies incident to
				other diagnostic services," and "surgical dressings";
(aa) "Pharmacy - Extension," only
				subcategories "single source drug," "multiple source drug," "restrictive
				prescription," "erythropoietin (EPO) less than ten thousand units,"
				"erythropoietin (EPO) ten thousand or more units," "drugs requiring detailed
				coding," and "self-administrable drugs";
(bb) "Cast room," only subcategory "general
				classification";
(cc) "Recovery
				room," only subcategory "general classification";
(dd) "Labor room/delivery," only
				subcategories "general classification," "labor," "delivery," and "birthing
				center";
(ee) "EKG/ECG
				(Electrocardiogram)," only subcategories "general classification," "holter
				monitor," and "telemetry";
(ff)
				"EEG (Electroencephalogram)," only subcategory "general
				classification";
(gg)
				"Gastro-intestinal services," only subcategory "general
				classification";
(hh) "Specialty
				room - Treatment/observation room," only subcategories "treatment room," and
				"observation room";
(ii)
				"Telemedicine," only subcategory "other telemedicine";
(jj) "Extra-corporeal shock wave therapy
				(formerly lithotripsy)," subcategory "general classification";
(kk) "Acquisition of body components," only
				subcategories "general classification," "living donor," and "cadaver
				donor";
(ll) "Hemodialysis -
				Outpatient or home," only subcategory "general classification";
(mm) "Peritoneal dialysis - Outpatient or
				home," only subcategory "general classification";
(nn) "Continuous ambulatory peritoneal
				dialysis (CAPD) - Outpatient or home," only subcategory "general
				classification";
(oo) "Continuous
				cycling peritoneal dialysis (CCPD) - Outpatient or home," only subcategory
				"general classification";
(pp)
				"Miscellaneous dialysis," only subcategories "general classification," and
				"ultra filtration";
(qq)
				"Behavioral health treatments/services," only subcategory "electroshock
				treatment";
(rr) "Behavioral
				health treatment/services," subcategories "intensive outpatient services -
				psychiatric";
(ss) "Behavioral
				health treatment/services," subcategories "partial hospitalization - less
				intensive," "partial hospitalization - intensive"; and
(tt) "Other diagnostic services," only
				subcategories "general classification," "peripheral vascular lab,"
				"electromyelogram," "pap smear," and "pregnancy test."