MedicaidReimbursementMedium impact
Revised policy for therapies for COVID-19
Washington Apple Health·WA · Emergency Medicine, Critical Care, Infectious Disease +1 more·Medical Policy
Effective date
Sep 1, 2022
We identified it
Jun 20, 2026
Summary
Washington State Health Care Authority (HCA) increased payment rates for COVID-19 therapies billed with PN modifier from 46% to full EAPG rates under their Outpatient Prospective Payment System fee schedule. This change applies retroactively to all claims with dates of service on or after September 1, 2022.
Action Required
Immediately: Billing team should review and resubmit any COVID-19 therapy claims with PN modifier that were paid at the lower 46% EAPG rate for dates of service September 1, 2022 and forward to receive the higher full EAPG rate payment. Update billing system rules to ensure PN modifier claims for COVID-19 therapies are processed at full EAPG rates going forward.