Effective for services on or after October 1, the Washington State Health Care Authority (HCA) increased the Medicaid professional fee schedule amounts for designated behavioral health, primary care, and pediatric critical care services. The new payment amounts reflect 15 percent increases for a range of behavioral health and adult primary care services and 21 percent increases for pediatric primary care and pediatric critical care services. HCA is following the same criteria it used for the temporary primary care increases under the Affordable Care Act, which includes office evaluation and management services by specialty care providers.
The increases were included in the 2021-2023 biennium budget passed by the legislature and apply to specific services for Medicaid enrollees paid directly by HCA and through the Medicaid managed care organizations. The HCA website links to fee schedules reflecting the codes and enhanced rates are below.
- https://www.hca.wa.gov/assets/billers-and-providers/mental-health-services-20211001.xlsx
- https://www.hca.wa.gov/assets/billers-and-providers/specialized-mental-health-20211001.xlsx
- https://www.hca.wa.gov/assets/billers-and-providers/enhanced-pediatric-20211001.xlsx
- https://www.hca.wa.gov/assets/billers-and-providers/enhanced-adult-20211001.xlsx
