Physician-Related Services Billing Guide updates

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Apple Health (Medicaid) Provider Alert

The Health Care Authority (the agency) published an updated Physician-Related Services Billing Guide, effective October 16, 2018. The updated guide is available on the agency’s Provider billing guides page.

What has changed?

The agency is making the following changes to the billing guide:

  • Moderate sedation codes: Retroactive to dates of service on and after July 1, 2018, the agency pays for moderate sedation in any appropriate setting, not only in the hospital or emergency department.

  • Fees schedules for Medication Assisted Treatment (MAT) and Enhanced Pediatric:  Added hyperlinks to the Medication Assisted Treatment (MAT) fee schedule and to the Enhanced Pediatric fee schedule.