Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-550 - Hospital services › Section 182-550-1400 - Covered and noncovered revenue codes categories and subcategories for inpatient hospital services

Current through Register Vol. 24-14, July 15, 2024
Subject to the limitations and restrictions listed, this
				  section identifies covered and noncovered revenue code categories and
				  subcategories for inpatient hospital services.
(1) The medicaid agency pays for an inpatient
				hospital covered service in the following revenue code categories and
				subcategories when the hospital provider accurately bills:
(a) "Room & board - Private (one bed),"
				only subcategories "general classification," "medical/surgical/gyn," "OB,"
				"pediatric," and "oncology";
(b)
				"Room & board - Semi-private (two bed)," only subcategories "general
				classification," "medical/surgical/gyn," "OB," "pediatric," and
				"oncology";
(c) "Room & board -
				Semi-private - (three and four beds)," only subcategories "general
				classification," "medical/surgical/gyn," "OB," "pediatric," and
				"oncology";
(d) "Room & board -
				Deluxe private," only subcategories "general classification,"
				"medical/surgical/gyn," "OB," "pediatric," and "oncology";
(e) "Nursery," only subcategories "general
				classification," "newborn - level I," "newborn - level II," "newborn -level
				III," and "newborn - level IV";
(f)
				"Intensive care unit," only subcategories "general classification," "surgical,"
				"medical," "pediatric," "intermediate ICU," "burn care," and
				"trauma";
(g) "Coronary care unit,"
				only subcategories "general classification," "myocardial infarction,"
				"pulmonary care," and "intermediate CCU";
(h) "Pharmacy," only subcategories "general
				classification," "generic drugs," "nongeneric drugs," "drugs incident to other
				diagnostic services," "drugs incident to radiology," "nonprescription," and "IV
				solutions";
(i) "IV therapy," only
				subcategories "general classification," "infusion pump," "IV therapy/pharmacy
				services," "IV therapy/drug/supply delivery" and "IV
				therapy/supplies";
(j)
				"Medical/surgical supplies and devices," only subcategories "general
				classification," "nonsterile supply," "sterile supply," "pacemaker,"
				"intraocular lens," and "other implant";
(k) "Oncology," only subcategory "general
				classification";
(l) "Laboratory,"
				only subcategories "general classification," "chemistry," "immunology,"
				"nonroutine dialysis," "hematology," "bacteriology &microbiology," and
				"urology";
(m) "Laboratory
				pathology," only subcategories "general classification," "cytology,"
				"histology," and "biopsy";
(n)
				"Radiology - Diagnostic," only subcategories "general classification,"
				"angiocardiography," "arthrography," "arteriography," and "chest
				X-ray";
(o) "Radiology -
				Therapeutic and/or chemotherapy administration," only subcategories "general
				classification," "chemotherapy administration - injected," "chemotherapy
				administration - oral," "radiation therapy," and "chemotherapy administration -
				IV";
(p) "Nuclear medicine," only
				subcategories "general classification," "diagnostic," "therapeutic,"
				"diagnostic radiopharmaceuticals," and "therapeutic
				radiopharmaceuticals";
(q) "CT
				scan," only subcategories "general classification," "head scan," and "body
				scan";
(r) "Operating room
				services," only subcategories "general classification" and "minor
				surgery";
(s) "Anesthesia," only
				subcategories "general classification," "anesthesia incident to radiology," and
				"anesthesia incident to other diagnostic services";
(t) "Administration, processing and storage
				for blood and blood component," only subcategories "general classification" and
				"administration";
(u) "Other
				imaging services," only subcategories "general classification," "diagnostic
				mammography," "ultrasound," and "positron emission tomography";
(v) "Respiratory services," only
				subcategories "general classification," "inhalation services" and "hyperbaric
				oxygen therapy";
(w) "Physical
				therapy," only subcategories "general classification," "visit charge," "hourly
				charge," "group rate," and "evaluation or reevaluation";
(x) "Speech therapy - Language pathology,"
				only subcategories "general classification," "visit charge," "hourly charge,"
				"group rate," and "evaluation or reevaluation";
(y) "Emergency room," only subcategories
				"general, urgent care classification" and "urgent care";
(z) "Pulmonary function," only subcategory
				"general classification";
(aa)
				"Cardiology," only subcategories "general classification," "cardiac cath lab,"
				"stress test," and "echocardiology";
(bb) "Ambulatory surgical care," only
				subcategory "general classification";
(cc) "Outpatient services," only subcategory
				"general classification";
(dd)
				"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";
(ee)
				"Medical/surgical supplies - Extension," only subcategories "supplies incident
				to radiology," "supplies incident to other diagnostic services," and "surgical
				dressings";
(ff)
				"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";
(gg) "Cast room," only subcategory "general
				classification";
(hh) "Recovery
				room," only subcategory "general classification";
(ii) "Labor room/delivery," only subcategory
				"general classification," "labor," "delivery," and "birthing center";
(jj) "EKG/ECG (Electrocardiogram)," only
				subcategories "general classification," "holter monitor," and
				"telemetry";
(kk) "EEG
				(Electroencephalogram)," only subcategory "general classification";
(ll) "Gastro-intestinal services," only
				subcategory "general classification";
(mm) "Treatment/observation room," only
				subcategories "general classification," "treatment room," and "observation
				room";
(nn) "Extra-corporeal shock
				wave therapy (formerly lithotripsy)," only subcategory "general
				classification";
(oo) "Inpatient
				renal dialysis," only subcategories "general classification," "inpatient
				hemodialysis," "inpatient peritoneal (non-CAPD)," "inpatient continuous
				ambulatory peritoneal dialysis (CAPD)," and "inpatient continuous cycling
				peritoneal dialysis (CCPD)";
(pp)
				"Acquisition of body components," only subcategories "general classification,"
				"living donor," and "cadaver donor";
(qq) "Miscellaneous dialysis," only
				subcategory "ultra filtration";
(rr) "Other diagnostic services," only
				subcategories "general classification," "peripheral vascular lab,"
				"electromyelogram," and "pregnancy test"; and
(ss) "Other therapeutic services," only
				subcategory "general classification."