Updated School-Based Health Care Services Billing Guide

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Apple Health (Medicaid) Provider Alert

An updated School-Based Health Care Services (SBHS) Billing Guide and SBHS Fee Schedule, effective January 1, 2018, are available on the SBHS webpage.

What has changed?

Three new codes have been added to the SBHS Billing Guide and SBHS Fee Schedule. School districts can begin using the new codes effective January 1, 2018 for date of service beginning January 1, 2018.

New Therapy Codes

Effective January 1, 2018, the Centers for Medicare and Medicaid Services (CMS) has replaced timed code 97532 (development of cognitive skills) with untimed code 97127 (therapeutic interventions that focus on cognitive function). 

Timed code 97762 (checkout for orthotic/prosthetic use) has been replaced with timed code 97763 (orthotic/prosthetic management and/or training). 

Audiologists, occupational therapists, physical therapists, and speech language pathologists should review the current 2018 CPT book or the AOTA, APTA, and ASHA websites for assistance with proper use of these codes.

New Behavioral Health Code

Effective January 1, 2018, the following provider types can bill for psychological assessments using untimed code 90791 (psychological diagnostic evaluation):

  • Licensed psychologist
  • Licensed independent clinical social worker (LiCSW)
  • Licensed advanced social worker (LiACSW)
  • Licensed mental health counselor (LMHC)

Code 96101 (psychological testing by psychologist) is still an approved code that licensed psychologists may use for psychological assessments. Mental health providers should review the current 2018 CPT book for assistance with proper use of these codes.

What else has changed?

Updates to the SBHS billing guide include general reorganization and language clarification throughout the guide. Language has been added in order to clarify the:

  • Provider revalidation process
  • IGT A-19 invoice process
  • Referral process for SBHS services
  • Evaluation and reevaluation reimbursement process
  • Billing process for nursing services provided by noncredentialed staff
  • List of eligible and non-eligible provider types
  • SBHS participation requirements including which entities can contract with the SBHS program
  • Role of the SBHS coordinator


Questions about the updated SBHS Billing Guide and SBHS Fee Schedule can be directed to the SBHS program specialist at shanna.muirhead@hca.wa.gov or 360-725-1153.

Thank you!


The Washington State School-Based Health Care Services (SBHS) program is administered by the Health Care Authority (HCA). School districts participating in the SBHS program may receive reimbursement for providing health care-related services to Medicaid-eligible students with Individualized Education Programs (IEPs) and Individualized Family Service Plans (IFSPs). Visit the SBHS webpage for more information.

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