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296-23A-0220  <<  296-23A-0221 >>   296-23A-0230

WAC 296-23A-0221

Agency filings affecting this section

How does the self-insurer pay for hospital outpatient services?

The self-insurer will pay for hospital outpatient services according to the following table:
Hospital Type or Service Location
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
Yes, paid 100% of allowed charges
Yes
Chronic Pain Management Program
Not Applicable
Not Applicable
Health Maintenance Organizations
Yes, paid 100% of allowed charges
Yes
Military
Yes, paid 100% of allowed charges
No, paid 100% of allowed charges
Veterans Administration
Yes, paid 100% of allowed charges
No, paid 100% of allowed charges
State psychiatric facility
Yes, paid 100% of allowed charges
Yes
Other psychiatric hospitals
Yes, applies to hospital outpatient services except radiology, laboratory, pathology, occupational therapy, and physical therapy
Yes
Rehabilitation hospitals
Yes, applies to hospital outpatient services except radiology, laboratory, pathology, occupational therapy, and physical therapy
Yes
Cancer hospitals
Yes, applies to hospital outpatient services except radiology, laboratory, pathology, occupational therapy, and physical therapy
Yes
All other Washington hospitals
Yes, applies to hospital outpatient services 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 the 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.
[Statutory Authority: RCW 51.04.030 and 51.12.330. WSR 06-12-073, § 296-23A-0221, filed 6/6/06, effective 7/7/06. Statutory Authority: RCW 51.04.020, 51.04.030, 51.36.080, 51.36.085. WSR 01-24-045, § 296-23A-0221, filed 11/29/01, effective 1/1/02.]