Wash. Admin. Code § 296-23A-0220
The department will pay for hospital outpatient services according to the following table:
Hospital Type or Service Location | Does the Ambulatory Payment Classification System apply? | Do percent of allowed charges (POAC) payment methods apply? | Do the department's Medical Aid Rules and Fee Schedules apply to hospital outpatient radiology, laboratory, pathology, occupational therapy, and physical therapy services? |
Children's hospitals | No | Yes, paid 100% of allowed charges | Yes |
Chronic Pain Management Program | No | Exempt, paid per department agreement | Exempt, paid per department agreement |
Health Maintenance Organizations | Yes, paid statewide average per APC rate | Yes, applies to certain hospital outpatient services excluded from OPPS except radiology, laboratory, pathology, occupational therapy, and physical therapy | Yes |
Military | No | Yes, paid 100% of allowed charges | No, paid 100% of allowed charges |
Veterans Administration | No | Yes, paid 100% of allowed charges | No, paid 100% of allowed charges |
State psychiatric facility | No | Yes, paid 100% of allowed charges | Yes |
Other psychiatric hospitals | No | Yes, applies to hospital outpatient services except radiology, laboratory, pathology, occupational therapy, and physical therapy | Yes |
Rehabilitation hospitals | No | Yes, applies to hospital outpatient services except radiology, laboratory, pathology, occupational therapy, and physical therapy | Yes |
Cancer hospitals | No | Yes, applies to hospital outpatient services except radiology, laboratory, pathology, occupational therapy, and physical therapy | Yes |
Critical access hospitals | No | Yes, applies to hospital outpatient services except radiology, laboratory, pathology, occupational therapy, and physical therapy | Yes |
All other Washington hospitals | Yes | Yes, applies to certain hospital outpatient services excluded from OPPS except radiology, laboratory, pathology, occupational therapy, and physical therapy | Yes |
Hospitals are reimbursed only for the technical component of rates listed in the fee schedules, for outpatient radiology, pathology and laboratory services.
See chapter 296-23 WAC for rules on radiology, pathology, laboratory, physical therapy, occupational therapy, and work hardening services.
See WAC 296-23A-700 for rules on prospective payment system for hospital outpatient services.
See WAC 296-20-132 and 296-20-135 for information on the conversion factor used for certain hospital outpatient services.
Wash. Admin. Code § 296-23A-0220
Statutory Authority: RCW 51.04.030 and 51.12.330. 06-12-073, § 296-23A-0220, filed 6/6/06, effective 7/7/06. Statutory Authority: RCW 51.04.020, 51.04.030, 51.36.080, 51.36.085. 01-24-045, § 296-23A-0220, filed 11/29/01, effective 1/1/02. Statutory Authority: RCW 51.04.020, 51.04.030, 51.36.080. 00-06-027, § 296-23A-0220, filed 2/24/00, effective 3/26/00; 97-06-066, § 296-23A-0220, filed 2/28/97, effective 4/1/97.