Physician-Related Services/Health Care Professional Services Billing Guide updates

Washington State Health Care Authority sent this bulletin at 01/29/2021 04:09 PM PST

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Apple Health (Medicaid) Provider Alert

The Health Care Authority (HCA) revised the Physician-Related Services/Health Care Professional Services Billing Guide, dated February 1, 2021.

What has changed?

In the Prolonged services with direct patient contact section, HCA did the following:

Added a table for HCPCS code G2212
Added that time counted toward payment for prolonged E/M services includes direct face-to-face contact between the provider and the client or time at the bedside on the floor, even if the time spent was not continuous.
Revised CPT® code tables to reflect the addition and deletion of CPT® codes

For specific details, see the What has changed table in the revised guide.

About the Health Care Authority (HCA)

The Washington State Health Care Authority (HCA) is committed to whole-person care, integrating physical health and behavioral health services for better results and healthier residents.

HCA purchases health care for more than 2.5 million Washington residents through Apple Health (Medicaid), the Public Employees Benefits Board (PEBB) Program, the School Employees Benefits Board (SEBB) Program, and the COFA Islander Health Care Program. As the largest health care purchaser in the state, we lead the effort to transform health care, helping ensure Washington residents have access to better health and better care at a lower cost.

Please do not reply directly to this message. For more information, visit the HCA website, where you'll also find contact information.

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The Washington State Health Care Authority (HCA) complies with all applicable federal and Washington state civil rights laws and is committed to providing equal access to our services. Visit HCA’s website to view complete nondiscrimination statements.