SHJ25-007 Kittitas County and Wellpoint Agreement - PARTIALLY EXECUTED

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Specialty Provider Individual and/or group (including Non -MD or DO) shall be reimbursed for anesthesiology services in accordance with the accumulation of base, modifier and time units multiplied by the Washington State Medicaid Anesthesia Conversion Factor. The services should be billed in minute increments. One time unit will be allowed for each fifteen (15) minute interval, or fraction thereof, starting from the time Provider begins to prepare the Member for induction and ending when the Member may safely be placed under post -operative supervision and Provider is no longer in personal attendance. "Ambulatory Patient Group" ("APG") means the Wellpoint Rate that is a fixed reimbursement to a facility for Outpatient Services and which incorporates data regarding the reason for the visit and patient data. "Ambulatory Payment Classification" ("APC") or its successor shall have the meaning set forth in the Medicare law and CMS regulations and guidance. "Wellpoint DMEPOS and PEN Fee Schedule" means the applicable Wellpoint DMEPOS and PEN Fee Schedule for the market(s) and programs) covered by the Agreement. The parties acknowledge and agree that the Wellpoint DMEPOS and PEN Fee Schedule is subject to modification by Wellpoint at any time during the term of the Agreement. Wellpoint DMEPOS and PEN Fee Schedule and/or rate changes will be applied on a prospective basis. "Wellpoint Reference Laboratory Fee Schedule" means the Wellpoint Rate that is the Wellpoint Reference Laboratory Fee Schedule that is based on the Medicare Fee Schedule and may contain additional CPT/HCPCS codes. Wellpoint Reference Laboratory Fee Schedule and/or rate changes will be applied on a prospective basis. The Wellpoint Reference Laboratory Fee Schedule contains all codes from the Medicare Clinical Laboratory Fee Schedule, pathology codes from the Medicare Physician Fee Schedule, and additional codes added by Plan. "Wellpoint Medicaid Rate(s)/Fee Schedule(s)/Methodologies" means the Wellpoint Medicaid Rates)/Fee Schedule(s)/ in effect on the date of service for the provider type(s)/service(s) identified herein for the applicable Medicaid Prograrl "CMS Outpatient Prospective Payment System" ("OPPS") shall have the meaning set forth in Medicare law and CMS regulations and guidance. "Medical Care Management Rate" means the amount paid by Wellpoint to Provider on a per member per month basis for facilitation of collaborative programs meant to manage medical/social/mental health conditions more effectively. "Medicare Fee Schedule" means the applicable Medicare Fee Schedule for the provider type(s) identified herein, including payment conversion factor, where applicable, and in effect on the date of the service is initiated to Members. Medicare Fee Schedule and/or rate changes will be applied on a prospective basis. "Medicare LUPA National Base Rate" means the Medicare LUPA ("Low Utilization Payment Adjustment") National Base rate in effect as of the date of service for the market(s) and program(s) covered by the Agreement at the time the Covered Services are initiated to the Member. Medicare LUPA National Base Rate changes will be applied on a prospective basis. "Medicare Part B Drug Average Sales Price ("ASP") Fee Schedule" means the Medicare Part B Drug Average Sales Price ("ASP") Fee Schedule (or successor) in effect as of the date of service for the markets) and programs covered by the Agreement at the time the Covered Services is initiated to the Member. Medicare Part B Drug Average Sales Price ("ASP") Fee Schedule and/or rate changes will be applied on a prospective basis. "Washington State Medicaid Rate(s)/Fee Schedule(s)/Methodologies" means the Washington State Medicaid Rate(s)/Fee Schedule(s)/ in effect on the date of service for the provider type(s)lservice(s) identified herein for the applicable Medicaid Program(s). Washington Enterprise Provider Agreement PCs Attachment 37 1183932156 Medicaid — Specialist Physician Grp 05/05l2025 ©2024 Sept— Wellpolnt Washington, Inc.