Apple Health Billing Guide Updates, Effective 1/1/2021

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Apple Health (Medicaid) Provider Alert

The Health Care Authority (HCA) is publishing quarterly updates to m­­­any of the Apple Health billing guides, effective January 1, 2021. Billing guides are located on HCA’s Provider billing guides and fee schedules webpage. Check the webpage often. HCA is loading the revised billing guides as soon as they are finalized for publishing.

Note regarding new procedure codes
HCA is currently reviewing a long list of newly released procedure codes. These procedure codes and accompanying policy language have not been added to the billing guide(s) yet. If additional updates are required, new guides will be published on or before February 1, 2021. HCA will notify providers if updates occur.

Any 1st quarter procedure codes that are activated in the February 1st update will be retroactive in ProviderOne for claims with dates of service on and after January 1, 2021. This does not include the new evaluation and management (E/M) procedure codes which are already effective in the ProviderOne system for January 1, 2021.