Provider billing guides and fee schedules
This page contains billing guides, fee schedules, and additional billing materials to help you submit:
- Prior authorization (PA) for services
- Claims
Stay up-to-date with rate and billing changes, and ProviderOne system changes.
Prior authorization (PA)
Before you provide certain services, you will need to submit authorization request forms. Use the ProviderOne portal to see if a client is eligible for the service and the billing guides and fee schedules to determine if a PA is required.
For step-by-step instructions on completing a PA, visit our Prior authorization (PA) page.
Do you need a PA form? Visit our Forms and publications page to download authorization forms.
Claims
After you complete a service, you file claims through the ProviderOne portal. Use the billing guides and fee schedules to find rate information and the ProviderOne Billing and Resource Guide to walk through the claims process.
Billing guides and fee schedules
Use our billing guides and fee schedules to determine if a PA is required and assist in filing claims.
Jump to the first list item for each letter: A B C D E F G H I J K L M N O P Q R S T U V W X Y Z
- A -
- Access to baby and child dentistry/Mouth Matters (ABCD)
-
Billing guides
- November 1, 2024 to present - ABCD billing guide
- July 1, 2024 to October 31, 2024 — ABCD billing guide
- April 1, 2023 to June 30, 2024 — ABCD Mouth matters billing guide
- View all ABCD billing guides
Fee schedules
See Dental Program.
- Acute physical medicine and rehabilitation
-
Billing guides
- July 1, 2024 to present — Acute physical medicine and rehabilitation billing guide
- July 1, 2022 to June 30, 2024 — Acute physical medicine and rehabilitation billing guide
- October 1, 2020 to June 30, 2022 — Acute physical medicine and rehabilitation billing guide
- View all acute physical medicine and rehabilitation billing guides
- Alien Medical Program emergency assistance
-
Billing guides
- Ambulance transportation
-
Billing guides
Ambulance transportation
- November 1, 2024 to present - Ambulance transportation billing guide
- May 12, 2023 to October 31, 2024 — Ambulance transportation billing guide
- January 1, 2021 to May 11, 2023 — Ambulance transportation billing guide
- July 1, 2020 to December 31, 2020 — Ambulance transportation billing guide
- View all Ambulance transportation billing guides
Ground Emergency Medical Transportation (GEMT)
- July 1, 2022 to present — Ground Emergency Medical Transportation (GEMT) billing guide
- October 1, 2020 to June 30, 2022 — Ground Emergency Medical Transportation (GEMT) billing guide
- January 1, 2020 to September 30, 2020 — Ground Emergency Medical Transportation (GEMT) billing guide
- View all GEMT billing guides
Fee schedules
- July 1, 2023 to present — Ambulance transportation (published July 12, 2023)
- July 1, 2021 to June 30, 2023 — Ambulance transportation (updated March 17, 2022)
- February 29, 2020 to June 30, 2021 — Ambulance transportation (updated April 17, 2020)
- July 1, 2019 to February 28, 2020 — Ambulance transportation (updated May 29, 2019)
- December 1, 2016 to June 30, 2019 — Ambulance transportation (updated December 09, 2016)
- January 1, 2006 to November 30, 2016 — Ambulance transportation (updated February 10, 2016)
Additional materials
- Ambulatory surgery centers (ASCs)
-
Billing guides
- July 1, 2024 to present — ACS billing guide
- July 1, 2022 to June 30, 2024 — ACS billing guide
- July 1, 2021 to June 30, 2022 — ASC billing guide
- View all ASC billing guides
Fee schedules
- October 1, 2024 to present -- ASC fee schedule (published October 2, 2024)
- July 1, 2024 to September 30, 2024 — ASC fee schedule (updated August 26, 2024)
- April 1, 2024 to June 30, 2024 — ASC fee schedule (updated May 29, 2024)
- January 1, 2024 to March 31, 2024 — ASC fee schedule (updated May 15, 2024)
- October 1, 2023 to December 31, 2023 — ASC fee schedule (updated May 15, 2024)
- July 1, 2023 to September 30, 2023 — ASC fee schedule (published May 15, 2024)
- April 1, 2023 to June 30, 2023 — ASC fee schedule (May 15, 2024)
- October 1, 2022 to March 31, 2023 — ASC fee schedule (updated March 7, 2024)
- April 1, 2022 to September 30, 2022 — ASC fee schedule (updated August 12, 2022)
- October 1, 2021 to March 31, 2022 — ASC fee schedule (updated December 16, 2021)
- March 1, 2021 to September 30, 2021 — ASC fee schedule (updated June 8, 2021)
- View all ASC fee schedules
- Applied behavior analysis (ABA)
-
Billing guides
- July 1, 2024 to present — ABA billing guide
- April 1, 2024 to June 30, 2024 — ABA billing guide
- January 1, 2024 to March 31, 2024 — ABA billing guide
- View all ABA billing guides
Fee schedules
- July 1, 2024 to present — ABA fee schedule (published June 26, 2024)
- January 1, 2024 to June 30, 2024 — ABA fee schedule (published December 21, 2023)
- July 1, 2023 to December 31, 2023 — ABA fee schedule (published June 29, 2023)
- View all ABA fee schedules
Centers of Excellence
- B -
- Blood bank services
-
Billing guides
Discontinued 3/31/2013. Refer to the current Physician-related/professional services for information regarding blood, blood products, and related services.
Fee schedules
- July 1, 2024 to present — Blood bank fee schedule (published June 26, 2024)
- July 1, 2023 to June 30, 2024 — Blood bank fee schedule (published June 29, 2022)
- July 1, 2022 to June 30, 2023 — Blood bank fee schedule (published June 29, 2022)
- View all Blood Bank services fee schedules
- C -
- Chemical-Using Pregnant (CUP) Program
-
Billing guides
- January 1, 2023 to present — Refer to the Substance-Using Pregnant People (SUPP) program billing guide.
- January 1, 2022 to December 31, 2022 — CUP program billing guide
- October 1, 2020 to December 31, 2021 — CUP women program billing guide
- July 1, 2019 to September 30, 2020 — CUP women program billing guide
- View all CUP billing guides
Fee schedule (reimbursement/rates)
See Inpatient Prospective Payment System (IPPS) on the Hospital reimbursement page.
Additional information
- Childbirth education
-
Billing guides
- January 1, 2024 to present — Childbirth education billing guide
- October 1, 2023 to December 31, 2023 — Childbirth education billing guide
- October 1, 2020 to September 30, 2023 — Childbirth education billing guide
- View all childbirth education billing guides
Fee schedules
- January 1, 2007 to present — Childbirth education (updated June 23, 2010)
- Chiropractic services for children
-
Billing guides
- July 1, 2024 to present — Chiropractic services billing guide
- July 1, 2022 to June 30, 2024 — Chiropractic services billing guide
- October 1, 2020 to June 30, 2022 — Chiropractic services billing guide
- View all chiropractic services for children billing guides
Fee schedules
- July 1, 2024 to present — Chiropractic services for children fee schedule (published June 26, 2024)
- July 1, 2023 to June 30, 2024 — Chiropractic services for children fee schedule (published June 29, 2023)
- July 1, 2022 to June 30. 2023 — Chiropractic services for children fee schedule (published June 29, 2022)
- View all chiropractic services for children fee schedules
- Community Behavioral Health Support (CBHS) services
-
Billing guides
Fee schedules
- July 1, 2024 to present — CBHS services fee schedule (published July 16, 2024)
- Complex rehabilitation technology (CRT)
-
Billing guides
- November 1, 2024 to present - CRT products and services billing guide
- July 1, 2024 to October 31, 2024 — CRT products and services billing guide
- April 1, 2024 to June 30, 2024 — CRT products and services billing guide
- April 1, 2023 to March 31, 2024 — CRT products and services billing guide
- View all CRT billing guides
Fee schedules
- October 1, 2024 to present — CRT fee schedule (published September 30, 2024)
- July 1, 2024 to September 30, 2024 — CRT fee schedule (updated July 1, 2024)
- April 1, 2024 to June 30, 2024 — CRT fee schedule (published March 27, 2024)
- View all CRT fee schedules
Social services (see appropriate fee schedule for rate)
- COVID-19
-
Fee schedules
- January 1, 2024 to present — COVID-19 fee schedule (published December 21, 2023)
- October 1, 2023 to December 31, 2023 — COVID-19 fee schedule (updated November 6, 2023
- July 1, 2023 to September 30, 2023 — COVID-19 fee schedule (published June 29, 2023)
- View all COVID-19 fee schedules
Policies and billing guidance
Apple Health COVID-19 vaccine policy
Effective October 1, 2024, this guide has been discontinued. Please refer to the EPSDT Well-Child Program Billing Guide, and the Physician-Related Services/Health Care Professional Services Guide for immunization/vaccine policies.
- October 11, 2023 to September 30, 2024 — Apple Health COVID-19 vaccine policy
- June 1, 2023 to October 10, 2023 — Apple Health COVID-19 vaccine policy (updated 6/21/2023)
- May 9, 2023 to May 31, 2023 — Apple Health COVID-19 vaccine policy
- View all COVID-19 vaccine policies
Apple Health Monoclonal Antibody Treatment COVID-19 clinical policy
- August 17, 2023 to present — Apple Health Monoclonal Antibody Treatment COVID-19 clinical policy: Medical policy no. 19.50.20
- April 24, 2023 to August 16, 2023 — Apple Health Monoclonal Antibody Treatment COVID-19 clinical policy: Medical policy no. 19.50.20
- December 16, 2022 to April 23, 2023 — Therapies for COVID-19: Medical policy no. 19.50.20
- September 14, 2022 to December 15, 2022 — Therapies for COVID-19: Medical policy no. 19.50.20
- August 19, 2022 to September 13, 2022 — Therapies for COVID-19: Medical policy no. 19.50.20
- May 10, 2022 to August 18, 2022 — Therapies for COVID-19: Medical policy no. 19.50.20
- April 12, 2022 to May 9, 2022 — Therapies for COVID-19: Medical policy no. 19.50.20
- March 23, 2022 to April 11, 2022 — Therapies for COVID-19: Medical policy no. 19.50.20
- View all Monoclonal Antibody Treatment COVID-19 clinical policies
Apple Health COVID-19 testing clinical policy
Effective February 1, 2024, this guide has been discontinued. Please refer to individual program billing guides for COVID-19 testing clinical policy.
- January 1, 2024 to January 31, 2024 — Apple HealthCOVID-19 testing clinical policy
- May 12, 2023 to December 31, 2023 — Apple Health COVID-19 testing clinical policy (updated May 23, 2023)
- November 21, 2022 to May 11, 2023 — Apple Health COVID-19 testing clinical policy
- View all COVID-19 testing clinical policies
- D -
- Dental Program
-
Billing guides
Access to Baby and Child Dentistry (ABCD)
See Access to Baby and Child Dentistry (ABCD).
Dental-related services
- October 1, 2024 to present - Dental-related services program billing guide
- July 1, 2024 to September 30, 2024 — Dental-related services program billing guide
- April 1, 2024 to June 30, 2024 — Dental-related services program billing guide
- View all dental services billing guides
Oral Health Connections (OHC) pilot project (Pilot project ended 12/31/2023)
- July 1, 2022 to December 31, 2023 — Oral Health Connections pilot project billing guide
- January 1, 2022 to June 30, 2022 — Oral Health Connections pilot project billing guide
- October 1, 2020 to December 31, 2021 — Oral Health Connections pilot project billing guide
- View all OHC pilot project billing guides
Mobile anesthesia
- February 1, 2024 to present — Mobile anesthesia for dental services billing guide
- July 1, 2022 to January 31, 2024 — Mobile anesthesia for dental services billing guide
Fee schedules
- October 1, 2024 to present — Dental program fee schedule (published September 30, 2024)
- July 1, 2024 to September 30, 2024 — Dental program fee schedule (published June 26, 2024)
- April 1, 2024 to June 30, 2024 — Dental program fee schedule (published March 28, 2024)
- View all dental services fee schedules
- Diabetes Education Program
-
Billing guides
- July 1, 2024 to present — Diabetes education program billing guide
- July 1, 2023 to June 30, 2024 — Diabetes education program billing guide
- July 1, 2022 to June 30, 2023 — Diabetes education program billing guide
- View all Diabetes Education Program billing guides
Fee schedules
- July 1, 2024 to present — Diabetes education (published June 26, 2024)
- July 1, 2023 to June 30, 2024 — Diabetes education (published June 29, 2023)
- July 1, 2022 to June 30, 2023 — Diabetes education (published June 29, 2022)
- View all diabetes education fee schedules
- Durable medical equipment (DME)
-
Billing guides
- April 1, 2019 to present — Refer to the Medical Equipment and Supplies billing guide for information regarding durable medical equipment.
- January 1, 2019 to March 31, 2019 — DME and non-CRT wheelchairs billing guide
- October 1, 2018 to December 31, 2018 — DME and non-CRT wheelchairs billing guide
- July 1, 2018 to September 30, 2018 — DME and non-CRT wheelchairs billing guide
- View all DME billing guides
Additional materials
- E -
- Early Periodic Screening, Diagnosis, and Treatment (EPSDT)
-
Billing guides
- October 1, 2024 to present - EPSDT Well-child program billing guide
- July 1, 2024 to September 30, 2024 — EPSDT Well-child program billing guide
- April 1, 2024 to June 30, 2024 — EPSDT Well-child program billing guide
- View all EPSDT billing guides
Fee schedules
- July 1, 2024 to present — EPSDT fee schedule (published June 26, 2024)
- January 1, 2024 to June 30, 2024 — EPSDT fee schedule (published December 21, 2023)
- July 1, 2023 to December 31, 2023 — EPSDT fee schedule (published June 29, 2023)
- View all EPSDT fee schedules
- Enteral nutrition
-
Billing guides
- July 1, 2024 to present — Enteral nutrition billing guide
- July 1, 2023 to June 30, 2024 — Enteral nutrition billing guide
- March 1, 2023 to June 30, 2023 — Enteral nutrition billing guide
- View all enteral nutrition billing guides
Fee schedules
- July 1, 2024 to present — Enteral nutrition fee schedule (published June 26, 2024)
- July 1, 2023 to June 30, 2024 — Enteral nutrition fee schedule (published June 29, 2023)
- March 1, 2023 to June 30, 2023 — Enteral nutrition fee schedule (published February 27, 2023)
- View all enteral nutrition fee schedules
- F -
- Family planning
-
Billing guides
- October 1, 2024 to present — Family planning billing guide
- July 1, 2024 to September 30, 2024 — Family planning billing guide
- May 1, 2024 to June 30, 2024 — Family planning billing guide
- View all family planning billing guides
Family planning fee schedules
- July 1, 2024 to present — Family planning fee schedule (updated October 30, 2024
- April 1, 2024 to June 30, 2024 — Family planning fee schedule (updated April 3, 2024)
- January 1, 2024 to March 31, 2024 — Family planning fee schedule (updated March 4, 2024)
- View all family planning fee schedules
SRHP fee schedules
- July 1, 2024 to present — SRHP fee schedule (Updated July 30, 2024)
- July 1, 2023 to June 30, 2024 — SRHP fee schedule (published June 29, 2023)
- July 1, 2022 to June 30, 2023 — SRHP fee schedule (updated May 16, 2023)
- View all SRHP fee schedules
Additional materials
- Sterilization Supplemental Billing Guide
- Physician-Related Services/Health Care Professional Services Billing Guide
- Physician administered drugs fee schedule
- Prescription Drug Program Billing Guide
Family planning
- Family planning program (family planning non-Medicaid)
- Family planning client application (form 13-781)
- Federally qualified health centers (FQHCs)
-
Billing guides
- October 1, 2024 to present - FQHC billing guide
- July 1, 2024 to September 30, 2024 — FQHC billing guide
- April 1, 2024 to June 30, 2024 — FQHC billing guide
- View all FQHC billing guides
Encounter rates
- October 1, 2024 to present — FQHC encounter rates (published September 30, 2024)
- July 1, 2024 to September 30, 2024 — FQHC encounter rates (updated September 30, 2024)
- April 1, 2024 to June 30, 2024 — FQHC encounter rates (updated September 30, 2024)
- View all FQHC encounter rates
Enhancement rates
- October 1, 2024 to present — FQHC enhancement rates (updated October 31, 2024)
- July 1, 2024 to September 30, 2024 — FQHC enhancement rates (updated October 15, 2024)
- April 1, 2024 to June 30, 2024 — FQHC enhancement rates (updated September 30, 2024)
- View all FQHC enhancement rates
- H -
- Habilitative services
-
Billing guides
- July 1, 2024 to present — Habilitative services program billing guide
- April 1, 2024 to June 30, 2024 — Habilitative services program billing guide
- August 1, 2022 to March 31, 2024 — Habilitative services program billing guide
- View all habilitative services billing guides
Fee schedules
- July 1, 2024 to present — Habilitative services (published June 26, 2024)
- January 1, 2024 to June 30, 2024 — Habilitative services (published May 23, 2024)
- July 1, 2023 to December 31, 2023 — Habilitative services (published June 29, 2023)
- View all habilitative services fee schedules
- Health-related social needs (HRSN)
-
The Health-Related Social Needs (HRSN) Services and In Lieu of Services (ILOS) Policy Guide provides information on new HRSN services available to people enrolled in Apple Health (Medicaid). Enrollees can receive these services through:
- ILOS – for managed care enrollees, or
- Through our state’s Section 1115 Medicaid demonstration waiver (called the Medicaid Transformation Project (MTP)) – for fee-for-service enrollees.
This guide explains when an HRSN service can be offered and the process that the Health Care Authority (HCA), MCOs, and providers must follow. For questions, please contact our MTP team.
Policy guides
- Hearing hardware
-
For Apple Health clients and clients of the Developmental Disabilities Administration.
Billing guides
- July 1, 2024 to present — Hearing hardware billing guide
- January 1, 2024 to June 30, 2024 — Hearing hardware billing guide
- April 1, 2022 to December 31, 2023 — Hearing hardware billing guide
- View all hearing hardware billing guides
Fee schedules
- July 1, 2024 to present — Hearing hardware fee schedule (published June 26, 2024)
- January 1, 2024 to June 30, 2024 — Hearing hardware fee schedule (published April 22, 2024)
- July 1, 2023 to December 31, 2023 — Hearing hardware fee schedule (published June 29, 2023)
- View all hearing hardware fee schedules
Social services (see appropriate fee schedule for rate)
- HIV/AIDS case management
-
Billing guides
- July 1, 2024 to present — HIV/AIDS case management billing guide
- April 1, 2022 to June 30, 2024 — HIV/AIDS case management billing guide
- April 1, 2021 to March 31, 2022 — HIV/AIDS case management billing guide
- View all HIV/AIDS program billing guides
Fee schedules
- July 1, 2018 to present — HIV/AIDS case management (Published June 26, 2018)
- Home health services (acute care services)
-
Billing guides
- July 1, 2024 to present — Home health (acute care services) billing guide
- May 7, 2024 to June 30, 2024 — Home health (acute care services) billing guide
- October 1, 2023 to May 6, 2024 — Home health (acute care services) billing guide (Updated October 5, 2023)
- View all home health services billing guides
Fee schedules
- July 1, 2024 to present — Home health fee schedule (updated July 9, 2024)
- July 1, 2023 to June 30, 2024 — Home health fee schedule (published June 29, 2023)
- January 1, 2023 to June 30, 2023 — Home health fee schedule (published December 29, 2022)
- View all home health services fee schedules
- Home infusion therapy/parenteral nutrition
-
Billing guides
- July 1, 2024 to present — Home Infusion therapy billing guide
- January 1, 2023 to June 30, 2024 — Home Infusion therapy billing guide
- November 16, 2022 to December 31, 2022 — Home Infusion therapy billing guide
- View all home infusion therapy and nutrition billing guides
Fee schedules
- October 1, 2024 to present — Home infusion therapy/parenteral nutrition fee schedule (published September 30, 2024)
- July 1, 2024 to September 30, 2024 — Home infusion therapy/parenteral nutrition fee schedule (published June 26, 2024)
- July 1, 2023 to June 30, 2024 — Home infusion therapy/parenteral nutrition fee schedule (published June 29, 2023)
- View all home infusion therapy/parenteral nutrition fee schedules
Social services (see appropriate fee schedule for rate)
- Hospice
-
Billing guides
- July 1, 2024 to present — Hospice services billing guide
- July 1, 2022 to June 30, 2024 — Hospice services billing guide
- October 1, 2020 to June 30, 2022 — Hospice services billing guide
- View all hospice billing guides
Fee schedules
- October 1, 2024 to present — Hospice fee schedule (published September 30, 2024)
- January 1, 2024 to September 30, 2024 — Hospice fee schedule (published December 21, 2023)
- October 1, 2023 to December 31, 2023 — Hospice fee schedule (published September 29, 2023)
- View all hospice fee schedules
- Hospital-based inpatient detoxification
-
Billing guides
This guide was discontinued July 1, 2020. For information related to withdrawal management services (previously detox), please see the agency's inpatient hospital guide.
- January 1, 2020 to July 1, 2020 — Hospital-based inpatient detoxification billing guide
- July 1, 2019 to December 31, 2019 — Hospital-based inpatient detoxification billing guide
- January 1, 2019 to June 30, 2019 — Hospital-based inpatient detoxification billing guide
- View all hospital-based inpatient detoxification billing guides
- I -
- Inpatient hospital
-
Billing guides
- July 1, 2024 to present — Inpatient hospital services billing guide
- February 1, 2024 to June 30, 2024 — Inpatient hospital services billing guide
- January 1, 2024 to January 31, 2024 — Inpatient hospital services billing guide
- View all inpatient hospital billing guides
Fee schedule (reimbursement/rates)
See Inpatient Prospective Payment System (IPPS) on the Hospital reimbursement page.
Additional information
- Interpreter services
-
Billing guides
- K -
- Kidney center services
-
Billing guides
- July 1, 2024 to present — Kidney center services billing guide
- July 1, 2022 to June 30, 2024 — Kidney center services billing guide
- January 1, 2022 to June 30, 2022 — Kidney center services billing guide
- View all kidney center services billing guides
Fee schedules
- October 1, 2024 to present — Kidney centers fee schedule (published September 30, 2024)
- July 1, 2024 to September 30, 2024 — Kidney centers fee schedule (updated July 2, 2024)
- April 1, 2024 to June 30, 2024 — Kidney centers fee schedule (updated April 18, 2024)
- View all kidney center services fee schedules
- L -
- Long term acute care
-
Billing guides
- M -
- Maternity support services/infant case management (MSS/ICM)
-
Billing guides
- October 1, 2023 to present — MSS/ICM billing guide
- August 1, 2022 to September 30, 2023 — MSS/ICM billing guide
- July 1, 2022 to July 31, 2022 — MSS/ICM billing guide
- View all MSS/ICM billing guides
Fee schedules
- July 1, 2020 to present — MSS/ICM fee schedule (published July 1, 2020)
- January 1, 2020 to June 30, 2020 — MSS/ICM fee schedule (published January 9, 2020)
- Medical equipment and supplies
-
Billing guides
- July 1, 2024 to present — Medical Equipment and Supplies Billing Guide
- January 1, 2024 to June 30, 2024 — Medical Equipment and Supplies Billing Guide
- July 1, 2023 to December 31, 2023 — Medical Equipment and Supplies Billing Guide
- March 24, 2023 to June 30, 2023 — Medical Equipment and Supplies Billing Guide
- View all Medical equipment and supplies billing guides
Fee schedules
- October 1, 2024 to present — Medical Equipment and Supplies fee schedule (updated October 21, 2024)
- July 1, 2024 to September 30, 2024 — Medical Equipment and Supplies fee schedule (published June 26, 2024)
- January 1, 2024 to June 30, 2024 — Medical Equipment and Supplies fee schedule (updated January 4, 2024)
- View all medical equipment and supplies fee schedules
Social services (see appropriate fee schedule for rate)
- Medical nutrition therapy
-
Billing guides
- July 1, 2024 to present — Medical nutrition therapy billing guide
- November 8, 2023 to June 30, 2024 — Medical nutrition therapy billing guide
- July 1, 2023 to November 7, 2023 — Medical nutrition therapy billing guide
- View all medical nutrition therapy billing guides
Fee schedules
- July 1, 2024 to present — Medical nutrition therapy fee schedule (published June 26, 2024)
- July 1, 2023 to June 30, 2024 — Medical nutrition therapy fee schedule (published June 29, 2023)
- July 1, 2022 to June 30, 2023 — Medical nutrition therapy fee schedule (updated February 1, 2023)
- View all medical nutrition therapy fee schedules
Social services (see appropriate fee schedule for rate)
- Mental health services
-
Billing guides
- October 1, 2024 to present - Mental health services billing guide
- July 1, 2024 to September 30, 2024 — Mental health services billing guide
- April 1, 2024 to June 30, 2024 — Mental health services billing guide
- View all mental health services billing guides
Integrated Managed Care (IMC) Service Encounter Reporting
Fee schedules
Evaluation and treatment centers
- See Inpatient Prospective Payment System (IPPS) on the Hospital reimbursement page.
Mental health services
- October 1, 2024 to present — Mental health and psychology services fee schedule (published September 30, 2024)
- July 1, 2024 to September 30, 2024 — Mental health and psychology services fee schedule (published June 26, 2024)
- January 1, 2024 to June 30, 2024 — Mental health and psychology services fee schedule (published December 21, 2023)
- View all mental health services fee schedules
Specialized mental health services
- October 1, 2024 to present — Specialized mental health fee schedule (published September 30, 2024)
- July 1, 2024 to September 30, 2024 — Specialized mental health fee schedule (updated July 12, 2024)
- January 1, 2024 to June 30, 2024 — Specialized mental health fee schedule (updated April 2, 2024)
- View all specialized mental health services fee schedules
Additional materials
- N -
- Neurodevelopmental centers
-
Billing guides
- July 1, 2024 to present — Neurodevelopmental centers billing guide
- October 1, 2023 to June 30, 2024 — Neurodevelopmental centers billing guide (Updated October 5, 2023)
- July 1, 2023 to September 30, 2023 — Neurodevelopmental centers billing guide
- View all neurodevelopmental centers billing guides
Fee schedules
- July 1, 2024 to present — Neurodevelopmental centers fee schedule (published June 26, 2024)
- January 1, 2024 to June 30, 2024 — Neurodevelopmental centers fee schedule (published May 23, 2024)
- July 1, 2023 to December 31, 2023 — Neurodevelopmental centers fee schedule (published June 29, 2023)
- View all neurodevelopmental centers fee schedules
- Nondurable medical supplies and equipment
-
Billing guides
- April 1, 2019 to present — Refer to the Medical Equipment and Supplies billing guide for information regarding durable medical equipment.
- January 1, 2019 to March 31, 2019 — Nondurable medical supplies and equipment billing guides
- July 1, 2018 to December 31, 2018 — Nondurable medical supplies and equipment billing guides
- View all nondurable medical supplies and equipment billing guides
- Nursing facilities
-
Billing guides
- O -
- Orthodontic services
-
Billing guides
- July 1, 2024 to present — Orthodontic services billing guide
- April 1, 2024 to June 30, 2024 — Orthodontic services billing guide
- January 6, 2024 to March 31, 2024 — Orthodontic services billing guide
- View all orthodontic services billing guides
Fee schedules
See Dental Program.
- Outpatient hospital
-
Billing guides
- October 1, 2024 to present - Outpatient hospital services billing guide
- July 1, 2024 to September 30, 2024 — Outpatient hospital services billing guide
- April 1, 2024 to June 30, 2024 — Outpatient hospital services billing guide
- View all outpatient billing guides
Fee schedules
- October 1, 2024 to present -- OPPS fee schedule (updated October 24, 2024)
- July 1, 2024 to September 30, 2024 — OPPS fee schedule (updated October 4, 2024)
- April 1, 2024 to June 30, 2024 — OPPS fee schedule (updated July 1, 2024)
- January 1, 2024 to March 31, 2024 — OPPS fee schedule (updated July 1, 2024)
- October 1, 2023 to December 31, 2023 — OPPS fee schedule (updated March 13, 2024)
- July 1, 2023 to September 30, 2023 — OPPS fee schedule (updated March 13, 20243)
- April 1, 2023 to June 30, 2023 — OPPS fee schedule (updated March 13, 2024)
- January 1, 2023 to March 31, 2023 — OPPS fee schedule (updated March 13, 2024)
- October 1, 2022 to December 31, 2022 — OPPS fee schedule (updated July 27, 2023)
- View all outpatient fee schedules
Additional information
- Outpatient Rehabilitation Program
-
Billing guides
- July 1, 2024 to present — Outpatient rehabilitation billing guide
- January 1, 2024 to June 30, 2024 — Outpatient rehabilitation billing guide
- October 1, 2023 to December 31, 2023 — Outpatient rehabilitation billing guide (Updated October 5, 2023)
- View all Outpatient Rehabilitation Program billing guides
Fee schedules
- July 1, 2024 to present — Outpatient rehabilitation fee schedule (published June 26, 2024)
- January 1, 2024 to June 30, 2024 — Outpatient rehabilitation fee schedule (published December 21, 2023)
- July 1, 2023 to December 31, 2023 — Outpatient rehabilitation fee schedule (published June 29, 2023)
- View all Outpatient Rehabilitation Program fee schedules
Social services (see appropriate fee schedule for rate)
- P -
- Pharmacy special services, vaccine administration, and compliance packaging
-
Fee schedules
- July 1, 2024 to present — Pharmacy special services fee schedule (published June 26, 2024)
- July 1, 2023 to June 30, 2024 — Pharmacy special services fee schedule (published June 29, 2022)
- July 1, 2022 to June 30, 2023 — Pharmacy special services fee schedule (published June 29, 2022)
- View all pharmacy special services fee schedules
- Physician-related/professional services
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Billing guides
Pregnancy related services have been moved to the Pregnancy related services billing guide
- October 1, 2024 to present - Physician-related services/health care billing guide
- July 1, 2024 to September 30, 2024 — Physician-related services/health care billing guide
- April 1, 2024 to June 30, 2024 — Physician-related services/health care billing guide
- View all physician-related/professional services billing guides
Physician-related/professional services fee schedules
- October 1, 2024 to present — Physician-related services fee schedule (published September 30, 2024)
- July 1, 2024 to September 30, 2024 — Physician-related services fee schedule (updated August 14, 2024)
- April 1, 2024 to June 30, 2024 — Physician-related services fee schedule (updated May 21, 2024)
- View all physician-related/professional services fee schedules
Enhanced pediatric fee schedules
- October 1, 2024 to present — Enhanced pediatric fee schedule (published September 30, 2024)
- July 1, 2024 to September 30, 2024 — Enhanced pediatric fee schedule (updated August 5, 2024)
- January 1, 2024 to June 30, 2024 — Enhanced pediatric fee schedule (published December 21, 2023)
- View all enhanced pediatric fee schedules
Enhanced adult primary care fee schedules
- October 1, 2024 to present — Enhanced adult primary care fee schedule (published September 30, 2024)
- July 1, 2024 to September 30, 2024 — Enhanced adult primary care fee schedule (updated July 23, 2024)
- July 1, 2023 to June 30, 2024 — Enhanced adult primary care fee schedule (updated July 12, 2023)
- View all enhanced adult primary care fee schedules
Medication for Opioid Use Disorder (MOUD) fee schedules
- July 1, 2024 to present — Opioid use disorder fee schedule (published June 26, 2024)
- July 1, 2023 to June 30, 2024 — Opioid use disorder fee schedule (published June 29, 2023)
- January 1, 2023 to June 30, 2023 — Opioid use disorder fee schedule (published December 29, 2022)
- View all medication for opioid use disorder fee schedules
Conversion factors
- July 1, 2024 to present — Conversion factors (published June 26, 2024)
- July 1, 2023 to June 30, 2024 — Conversion factors (published June 29, 2023)
- July 1, 2022 to June 30, 2023 — Conversion factors (published June 29, 2022)
- View all conversion factors
Additional materials
- Planned home births and births in birth centers
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Billing guides
- October 1, 2024 to present — Planned home births and births in centers billing guide
- July 1, 2024 to September 30, 2024 — Planned home births and births in centers billing guide
- January 1, 2024 to June 30, 2024 — Planned home births and births in centers billing guide
- View all planned home births billing guides
Fee schedules
- July 1, 2024 to present — Planned home births and births in centers fee schedule (published June 27, 2024)
- January 1, 2024 to June 30, 2024 — Planned home births and births in centers fee schedule (published December 21, 2023)
- October 1, 2023 to December 31, 2023 — Planned home births and births in centers fee schedule (published September 28, 2023)
- View all planned home births fee schedules
- Pregnancy-related services
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Billing guides
Fee schedule
- Prenatal diagnosis genetic counseling
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Billing guides
(Effective October 1, 2015 this guide was merged into the physician-related services/health care professional services billing guide. See Physician-related/professional services.)
Fee schedules
(Effective October 1, 2024 these fee schedules were merged into the physician-related services/health care professional services fee schedule. See Physician-related/professional services)
- Prescription Drug Program
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Billing guides
- October 1, 2024 to present - Prescription drug program billing guide
- July 1, 2024 to September 30, 2024 — Prescription drug program billing guide
- June 8, 2024 to June 30, 2024 — Prescription drug program billing guide
- View all billing guides
Apple Health (Medicaid) expedited authorization (EA) lists
- June 8, 2024 to present — Expedited authorization codes and criteria table
- January 1, 2023 to June 7, 2024 — Expedited authorization codes and criteria table
- June 1, 2022 to December 31, 2022 — Expedited authorization codes and criteria table
- December 1, 2021 to May 31, 2022 — Expedited authorization codes and criteria table
- View all EA lists
For previous versions, email us Apple Health Pharmacy Policy.
Apple Health (Medicaid) preferred drug lists (PDLs)
Managed care plans and fee-for-service (FFS) plans
All agency-contracted managed care organizations (MCOs) and the fee-for-service (FFS) program use the Apple Health PDL.
The Apple Health PDL can be found on the agency's Apple Health PDL page.
FFS state maximum allowable cost (SMAC) list
To request an FFS change in reimbursement
Download the Pharmacy Information Authorization form (13-835A). Fax the request to: 833-991-0704.
- Private duty nursing
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Billing guides
- October 1, 2024 to present - Private duty nursing for children billing guide
- May 12, 2023 to September 30, 2024 — Private duty nursing for children billing guide
- February 21, 2023 to May 11, 2023 — Private duty nursing for children billing guide
- View all private duty nursing for children billing guides
Fee schedules
- October 1, 2024 to present — Private duty nursing fee schedule (published September 30, 2024)
- January 1, 2023 to September 30, 2024 — Private duty nursing fee schedule (updated August 29, 2023)
- January 1, 2020 to December 31, 2022 — Private duty nursing fee schedule (published December 19, 2019)
- View all private duty nursing fee schedules
Social services
- Social services supplement (updated October 1, 2024)
- View all social services blanket codes
- Professional administered drugs
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Fee schedules
- October 1, 2024 to present — Professional administered drug fee schedule (updated October 10, 2024)
- July 1, 2024 to September 30, 2024 — Professional administered drug fee schedule (updated September 9, 2024)
- April 1, 2024 to June 30, 2024 — Professional administered drug fee schedule (updated April 25, 2024)
- View all professional administered drugs fee schedules
- Prosthetics and orthotics
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Billing guides
- July 1, 2024 to present — Prosthetic and orthotic devices billing guide
- January 17, 2024 to June 30, 2024 — Prosthetic and orthotic devices billing guide
- October 1, 2023 to January 16, 2024 — Prosthetic and orthotic devices billing guide
- View all prosthetic and orthotics billing guides
Fee schedules
- October 1, 2024 to present — Prosthetic and orthotics fee schedule (published September 30, 2024
- July 1, 2024 to September 30, 2024 — Prosthetic and orthotics fee schedule (published June 26, 2024)
- January 1, 2024 to June 30, 2024 — Prosthetic and orthotics fee schedule (updated April 29, 2024)
- View all prosthetic and orthotics fee schedules
Social services (see appropriate fee schedule for rate)
- R -
- Respiratory care
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Billing guides
- July 1, 2024 to present — Respiratory care billing guide
- August 1, 2023 to June 30, 2024 — Respiratory care billing guide
- August 1, 2022 to July 31, 2023 — Respiratory care billing guide
- View all respiratory care billing guides
Fee schedules
- October 1, 2024 to present — Respiratory care fee schedule (published September 30, 2024)
- July 1, 2024 to September 30, 2024 — Respiratory care fee schedule (published June 26, 2024)
- January 1, 2024 to June 30, 2024 — Respiratory care fee schedule (updated April 8, 2024)
- View all respiratory care fee schedules
Social services (see appropriate fee schedule for rate)
- Rural health clinics (RHCs)
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Billing guides
- October 1, 2024 to present - Rural health clinics billing guide
- July 1, 2024 to September 30, 2024 — Rural health clinics billing guide
- April 1, 2024 to June 30, 2024 — Rural health clinics billing guide
- View all RHC billing guides
Encounter rates
- October 1, 2024 to present — RHC encounter rates (updated October 2, 2024)
- July 1, 2024 to September 30, 2024 — RHC encounter rates (updated October 2, 2024)
- April 1, 2024 to June 30, 2024 — RHC encounter rates (updated October 2, 2024)
- View all RHC encounter rates
Enhancement rates
- October 1, 2024 to present — RHC enhancement rates (updated October 31, 2024)
- July 1, 2024 to September 30, 2024 — RHC enhancement rates (updated October 15, 2024)
- April 1, 2024 to June 30, 2024 — RHC enhancement rates (updated September 30, 2024
- View all RHC enhancement rates
- S -
- School-based health care services (SBHS)
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Billing guides
- August 1, 2024 to present — SBHS billing guide
- October 1, 2023 to July 31, 2024 — SBHS billing guide (Updated October 13, 2023)
- August 1, 2023 to September 30, 2023 — SBHS billing guide
- View all SBHS billing guides
Fee schedules
- July 1, 2024 to present — SBHS fee schedule (published June 26, 2024)
- January 1, 2024 to June 30, 2024 — SBHS fee schedule (published December 21, 2023)
- July 1, 2023 to December 31, 2023 — SBHS fee schedule (published June 29, 2023)
- View all SBHS fee schedules
- Sleep centers
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Billing guides
- July 1, 2024 to present — Sleep centers billing guide
- January 1, 2023 to June 30, 2024 — Sleep centers billing guide
- July 1, 2022 to December 31, 2022 — Sleep centers billing guide
- View all sleep centers billing guides
Fee schedules
- July 1, 2024 to present — Sleep centers fee schedule (published June 26, 2024)
- July 1, 2023 to June 30, 2024 — Sleep centers fee schedule (published June 29, 2023)
- April 1, 2023 to June 30, 2023 — Sleep centers fee schedule (published March 29, 2023)
- View all sleep centers fee schedules
Centers of Excellence
- Sterilization
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Billing guides
- October 1, 2024 to present — Sterilization billing guide
- July 1, 2024 to September 30, 2024 — Sterilization billing guide
- January 1, 2024 to June 30, 2024 — Sterilization billing guide
- View all sterilization billing guides
Fee schedules
See Physician-related/professional services
Additional materials
- Substance Use Disorder Program
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Billing guides
- October 1, 2024 to present — Substance use disorder billing guide
(Fee-for-service benefits provided outside of the BHO process) - July 1, 2024 to September 30, 2024 — Substance use disorder billing guide
(Fee-for-service benefits provided outside of the BHO process) - April 1, 2024 to June 30, 2024 — Substance use disorder billing guide
(Fee-for-service benefits provided outside of the BHO process) - View all SUD (FFS outside BHO process) billing guides
- View all SUD (outpatient) billing guides
Substance Use Disorder fee schedules
- October 1, 2024 to present — Substance use disorder fee schedule (published September 30, 2024)
- January 1, 2024 to September 30, 2024 — Substance use disorder fee schedule (published December 21, 2023)
- October 1, 2023 to December 31, 2023 — Substance use disorder fee schedule (updated October 3, 2023)
- View all substance use disorder fee schedules
Problem Gambling fee schedules
- January 1, 2024 to present — Problem gambling fee schedule (published December 21, 2023)
- October 1, 2024 to present — Substance use disorder billing guide
- Substance-Using Pregnant People (SUPP) Program
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Billing guides
- October 1, 2023 to present — Substance-Using Pregnant People (SUPP) Program billing guide
- July 1, 2023 to September 30, 2023 — Substance-Using Pregnant People (SUPP) Program billing guide
- January 1, 2023 to June 30, 2023 ― Substance-Using Pregnant People (SUPP) Program billing guide
Fee schedule (reimbursement/rates)
See Inpatient Prospective Payment System (IPPS) on the Hospital reimbursement page.
Additional information
- T -
- Telehealth
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Telemedicine policy and billing
Physical health
- July 1, 2024 to present — Telemedicine billing guide
- January 1, 2025 - Telemedicine billing guide (early release may be revised)
- June 6, 2024 to June 30, 2024 — Telemedicine billing guide
- April 1, 2024 to June 5, 2024 — Telemedicine billing guide
- View all Telemedicine billing guides
Behavioral health
- September 7, 2023 to present — Apple Health (Medicaid) behavioral health policy and billing
- July 1, 2023 to September 6, 2023 — Apple Health (Medicaid) behavioral health policy and billing
Audio-only telemedicine
Physical health audio-only procedure codes
- January 1, 2024 to present — Apple Health (Medicaid) physical health audio-only procedure codes
- August 1, 2022 to December 31, 2023 — Apple Health (Medicaid) physical health audio-only procedure codes (Updated June 16, 2022)
Behavioral health audio-only procedure codes
- July 1, 2024 to present — Apple Health (Medicaid) audio-only behavioral health codes
- January 1, 2024 to June 31, 2024 — Apple Health (Medicaid) audio-only behavioral health codes
- January 1, 2023 to December 31, 2023 — Apple Health (Medicaid) audio-only behavioral health codes (updated February 15, 2023)
Telehealth services billing guide audio only supplement
- June 28, 2022 to July 31, 2022 — Telehealth services billing guide audio only supplement Refer to Telemedicine policy and billing
COVID-19 public health emergency policies
Clinical policy and billing for COVID-19
- July 1, 2023 to December 31, 2023 — Clinical policy for COVID-19
- May 12, 2023 to June 30, 2023 — Clinical policy for COVID-19
- August 1, 2022 to May 11, 2023 — Apple Health (Medicaid) clinical policy and billing for COVID-19
- July 22, 2022 to July 31, 2022 — Apple Health (Medicaid) clinical policy and billing
- February 1, 2022 to July 21, 2022 — Apple Health (Medicaid) clinical policy and billing
- January 1, 2022 to January 31, 2022 — Apple Health (Medicaid) clinical policy and billing
- View all clinical policy and billing FAQs
Telemedicine/telehealth brief — Effective January 1, 2022 see Clinical policy and billing
- June 6, 2020 to December 31, 2021 — Apple Health (Medicaid) telemedicine/telehealth brief
- May 10, 2020 to June 6, 2020 — Apple Health (Medicaid) telemedicine/telehealth brief
- April 29, 2020 to May 9, 2020 — Apple Health (Medicaid) telemedicine/telehealth brief
- View all telemedicine/telehealth briefs
Behavioral health policy and billing
- May 12, 2023 to June 30, 2023 — Apple Health (Medicaid) behavioral health policy and billing (updated April 17, 2023)
- August 1, 2022 to May 11, 2023 — Apple Health (Medicaid) behavioral health policy and billing
- View all behavioral health policy and billing FAQs
ABA policy and billing
- July 1, 2023 to September 30, 2023 — Apple Health (Medicaid) ABA FAQ
- July 22, 2022 to June 30,2023 — Apple Health (Medicaid) ABA policy and billing
- February 1, 2022 to July 21, 2022 — Apple Health (Medicaid) ABA policy and billing
- January 1, 2022 to January 31, 2022 — Apple Health (Medicaid) ABA policy and billing
- View all ABA policy and billing FAQs
FAQ for diabetes education providers
- July 1, 2023 to September 30, 2023 — Apple Health (Medicaid) FAQ for diabetes education providers
- July 22, 2022 to June 30, 2023 — Apple Health (Medicaid) FAQ for diabetes education providers
- February 1, 2022 to July 21, 2022 — Apple Health (Medicaid) FAQ for diabetes education providers
- View all FAQs for diabetes education providers
Home health services billing and policy during COVID-19 pandemic
- July 1, 2023 to September 30, 2023 — Apple Health (Medicaid) home health services
- May 3, 2020 to June 30, 2023 — Apple Health (Medicaid) home health services billing and policy during COVID-19 pandemic
- November 20, 2020 to May 2, 2021 — Apple Health (Medicaid) home health services billing and policy during COVID-19 pandemic
- October 1, 2020 to November 19, 2020 — Apple Health (Medicaid) home health services billing and policy during COVID-19 pandemic
- View all home health services billing and policy FAQs
Telehealth requirements for physical, occupational and speech therapy
- July 1, 2023 to September 30, 2023 — Telehealth requirements for physical, occupational, and speech therapy
- July 22, 2022 to June 30, 2023 — Telehealth requirements for physical, occupational and speech therapy
- February 1, 2022 to July 21, 2022 — Telehealth requirements for physical, occupational and speech therapy
- View all telehealth requirements for physical, occupational, and speech therapy
Telehealth services in long term care facilities and skilled nursing facilities
- July 1, 2023 to September 30, 2023 — Telehealth services in long term care facilities and skilled nursing facilities
- January 1, 2022 to June 30, 2023 — Telehealth services in long term care facilities and skilled nursing facilities
- May 3, 2021 to December 31, 2021 — Telehealth services in long term care facilities and skilled nursing facilities
- View all Telehealth requirements for LTC and SNF
Family planning only billing guide telemedicine/telehealth COVID-19
- July 1, 2023 to September 30, 2023 — Family planning only billing guide telemedicine/telehealth
- February 1, 2022 to June 30, 2023 — Family planning only billing guide telemedicine/telehealth
- January 1, 2022 to January 31, 2022 — Family planning only billing guide telemedicine/telehealth
- View all FPO Telehealth documents
- Transhealth Program
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Billing guides
- July 1, 2024 to present — Transhealth program billing guide
- April 1, 2024 to June 30, 2024 — Transhealth program billing guide
- April 1, 2023 to March 31, 2024 — Transhealth program billing guide
- January 1, 2023 to March 31, 2023 — Transhealth program billing guide
Fee schedules
- July 1, 2024 to present — Transhealth fee schedule (updated July 2, 2024)
- October 1, 2023 to June 30, 2024 — Transhealth fee schedule (updated May 21, 2024)
- July 1, 2023 to September 30, 2023 — Transhealth fee schedule (updated September 6, 2023)
- View all transhealth fee schedules
- Tribal Health Program
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Billing guides
- October 1, 2024 to present — Tribal health billing guide
- July 1, 2024 to September 30, 2024 — Tribal health billing guide
- June 8, 2024 to June 30, 2024 — Tribal health billing guide
- View all Tribal Health Program billing guides
Fee schedules
- January 1, 2024 to present — Tribal health program fee schedule (published December 21, 2023)
- January 1, 2023 to December 31, 2023 — Tribal health program fee schedule (updated March 15, 2023)
- January 1, 2022 to December 31, 2022 — Tribal health program fee schedule (published April 13, 2022)
- View all tribal health fee schedules
- V -
- Vision hardware for clients 20 years of age and younger
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Billing guides
- July 1, 2024 to present — Vision hardware billing guide
- July 1, 2022 to June 30, 2024 — Vision hardware billing guide
- January 21, 2022 to June 30, 2022 — Vision hardware billing guide
- View all vision hardware billing guides
Fee schedules
See Physician-related/professional services for information regarding vision exams and related services.
Vision hardware fee schedule is available through the ESD contract.