WAC 296-30-090   What are the maximum allowable fees?  (1) Maximum allowable fees for medical and mental health services, that are not hospital inpatient or outpatient services, are a percentage of those fees published in the medical aid rules and fee schedules, less any available benefits of public or private insurance.

EXCEPTION:

If any of the percentage of the maximum allowable fees in the medical aid rules and fee schedules, are lower than the maximum allowable fees for those procedures established by the department of social and health services under Title 74 RCW, the Title 74 RCW fees are the maximum allowable fees for those procedures.

     (2) The percent of allowed charges for authorized hospital inpatient and outpatient services billed by revenue codes are those rates established by the department. If the maximum allowable fees for hospital inpatient or outpatient services is lower than the maximum allowable fees for those procedures established under Title 74 RCW for the ratio of costs to charges (RCC) rate, the department will use the RCC rate as the percent of allowed charges for hospital inpatient and outpatient services, regardless of whether the hospital is diagnosis related group (DRG) exempt.



[Statutory Authority: Chapter 7.68 RCW. 11-22-054, § 296-30-090, filed 10/31/11, effective 12/1/11. Statutory Authority: RCW 7.68.030. 05-16-096, § 296-30-090, filed 8/2/05, effective 9/2/05. Statutory Authority: RCW 7.68.030, 7.68.080, 7.68.130. 00-03-056, § 296-30-090, filed 1/14/00, effective 2/14/00.]