Payment Changes for Pediatric Services and Medication Assisted Treatment Effective October 1, 2018

October 22, 2018

The Health Care Authority recently published an updated Physician-Related Services Billing Guide which is available on the agency’s Provider billing guides page. The guide includes information regarding recent changes to payment for pediatric evaluation and management services and Medication Assisted Treatment authorized by the legislature in the 2018 session.

  • Enhanced pediatric fee schedule. Effective October 1, certain services for Apple Health enrollees age 18 and younger, including vaccine administration and evaluation and management codes are paid an enhanced rate.  More information is available
  • Medication Assisted Therapy (MAT). Also effective October 1, Mediation Assisted Therapy services are paid an enhanced rate equivalent to Medicare payment rate. Since MAT is commonly billed using evaluation and management codes, providers of MAT must bill qualifying services using HCA’s expedited prior authorization (EPA) code process. Criteria and specific billing instructions are on page 163 of the billing guide. (Andrew Busz,


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