WSR 12-14-070



[ Filed July 2, 2012, 11:12 a.m. ]

Notice of Interpretive or Policy Statement

In accordance with RCW 34.05.230(12), following is a list of policy and interpretive statements issued by the health care authority (HCA).


Legal and Administrative Services

Document Title: Provider Notice #12-38.

Subject: Prosthetic-orthotic devices medicaid provider guide.

Effective Date: July 1, 2012.

Updating the coverage table-

o For consistency with other shoe codes, adding the limit of one pair every twelve months to codes A5501, A5503, A5504, A5505, A5506 (related to shoes for diabetics).
o For consistency with the EPA criteria coding table, adding the limit of one pair of oxford shoes every twelve months to L3215 and L3219.
o Correcting L6700, terminal device hook, by adding prior authorization. (No policy change.)

Updating instructions for the CMS-1500 Claim Form.

For additional information, contact Amber Dassow, HCA, P.O. Box 45504, phone (360) 725-1349, TDD/TTY 1-800-848-5429, fax (360) 586-9727, e-mail, web site

Washington State Code Reviser's Office