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Attention hospital providers:
Enhanced professional payments for trauma services:
As a reminder, the Health Care Authority (HCA) makes supplemental payments to designated trauma centers and pays enhanced rates to physicians/clinical providers for trauma cases that meet specified criteria.
Each qualifying trauma service or procedure on the provider's claim is paid at HCA's current fee-for-service rate, multiplied by the appropriate payment enhancement percentage at a rate of 275% of HCA's current fee-for-service rate for qualified trauma services, or other payment enhancement percentage HCA deems appropriate. Laboratory and pathology services and procedures are not eligible for payments from the Trauma Care Fund (TCF) and are paid at HCA's current fee-for-service rate.
For an eligible trauma service, payment is currently calculated as follows:
Trauma care payment = Base rate x 275%
Billing for trauma care services:
To bill for qualified trauma care services, physicians and clinical providers must add the trauma modifier ST to the appropriate procedure code line. Enter the required ST modifier into the modifier field of the claim to receive the enhanced payment.
Adjusting trauma claims:
HCA considers a provider’s request to adjust a claim for the purpose of receiving TCF payment (e.g., adding the ST modifier to a previously billed service, or adding a new procedure with the ST modifier to the claim) only when the adjustment request is received within 1 year from the date of service on the initial claim. See WAC 182-502-0150(11).
For additional information and criteria on enhanced payments for trauma services, see HCA’s Physician-Related Services/Health Care Professional Services Billing guide.
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