MedicaidBilling CodesHigh impact
Physician-related services billing guide updates, eff. 10/1/2026
Washington Apple Health·WA · Oncology, General Surgery, Urology +2 more·Billing Guide
Effective date
Oct 1, 2026
We identified it
Oct 1, 2026
Summary
Washington State HCA updated the Physician-Related Services Billing Guide effective October 1, 2026, with six key changes: removal of COVID-19 testing guidance, addition of HCPCS code S2068 for breast reconstruction, replacement of CPT 81479 with CPT 81542 for prostate genomic testing, relocation of drug administration codes to the Prescription Drug Program guide, elimination of prior authorization requirement for transient elastography, and update of the Collaborative Care Model attestation form to HCA 09-003.
Action Required
By September 30, 2026: (1) Billing team must update billing software to recognize and accept HCPCS code S2068 for breast reconstruction claims in the breast removal and reconstruction section. (2) Billing team must update all claim submission logic to STOP using CPT 81479 for Decipher prostate genomic testing and replace it with CPT 81542 effective 10/1/2026 to ensure proper claim processing. (3) Billing team must remove all prior authorization requirements for transient elastography from system workflows and encounter forms—this service no longer requires prior auth and claims will be improperly delayed if PA is requested. (4) Front desk and billing staff must update the Collaborative Care Model attestation form from the previous version to HCA 09-003 for all new attestations. (5) Billing team must review the updated HCA Physician-Related Services/Health Care Professional Services Billing Guide for any drugs previously administered in-office that have been moved to the Prescription Drug Program guide, and coordinate with providers to determine new billing workflows. (6) Providers should be notified of these changes before the effective date to avoid claim denials.