Outpatient Hospital Services Billing Guide - Effective 2/15/2022

Washington State Health Care Authority sent this bulletin at 02/17/2022 08:14 AM PST

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Apple Health (Medicaid) Provider Alert

Attention Outpatient Hospital providers:

The Health Care Authority (HCA) has published a revised Outpatient Hospital Services Billing Guide, dated February 15, 2022.

What has changed?

HCA has made the following changes:

Added a section to the guide explaining how hospital emergency departments (EDs) may bill for naloxone distributed to clients in an ED for dates of service on and after January 1, 2022. Effective January 1, 2022, 2SSB 5195, section 3, Chapter 273, Laws of 2021, directs hospital EDs to distribute opioid overdose reversal medication, naloxone, to people at risk of an opioid overdose.
Changed the definition of modifier PO and added a reference to 42 CFR § 419.48 for a description of excepted items and services.
Changed the cross-reference for Telemedicine located under Physician-related services/Health care professional services to HCA’s provider billing guides and fee schedules webpage

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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Nondiscrimination

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.

Outpatient Hospital Services Billing Guide - Effective 2/15/2022

Apple Health (Medicaid) Provider Alert

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About the Health Care Authority (HCA)

Disclosure notice

Nondiscrimination