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UNITED HEALTHCARE
<br />W ASHINGTON MEDICAID AND W ASHINGTON BENEFIT PLANS FOR THE UNINSURED BEHAVIORAL HEALTH PROFESSIONAL REIMBURSEMENT SCHEDULE
<br />oral sererq per diem
<br />J]A9)!IP
<br />Sp296
<br />9g3.96
<br />56296
<br />ux4xA
<br />Tnnapen «Jmnadnrvlxmiea.pertlem
<br />JmroP
<br />.e S9
<br />]br 94
<br />saz96
<br />o-t9rlP
<br />lo-s
<br />]m
<br />IGk�6
<br />xx4u
<br />enmmnnrey Wsee wrap.arvnm aerries. per lsminnrr,
<br />o-loro-P
<br />lot
<br />lei
<br />214AM
<br />301
<br />µI
<br />itrl
<br />PI-i
<br />G.-iN WSMwrap.amuM servies. per 15-.P.
<br />aJ99ft]P
<br />]OI
<br />let
<br />1.1
<br />per tlicm
<br />4ltulty
<br />53,91
<br />H292t
<br />[emman rybasetl wmp areuM xrtitts, pee diem
<br />4Z4IO1
<br />53.4E
<br />53,9E
<br />51
<br />5392
<br />pn tlicm
<br />53,9E
<br />539E
<br />HNI2£
<br />Cnmmamtr-Wsetl er,porvuM rerdrq pe. diem
<br />£199914P
<br />53.92
<br />53,9E
<br />53.9E
<br />p<r Mem
<br />o-xp/tP
<br />5392
<br />51.9E
<br />HNIt2
<br />lti
<br />fnmmun eYW3etl xe,prmwd reruns, per diem
<br />P
<br />53.92
<br />53.9Ediem
<br />911P
<br />SIR
<br />ILI-
<br />]G
<br />ilr-based ma amdrd servicespn diem
<br />910P
<br />539E
<br />51.9EmulPN2p33
<br />5appudN emtxmvnentper l5 mamas
<br />OP
<br />]G6
<br />10G9fIPHib2]
<br />Parted emplrnnent
<br />lcmpbvmrnt.
<br />XI
<br />]06
<br />per JS minuxz
<br />IP
<br />ntaeemp/OP
<br />SgG
<br />OG
<br />99fIP
<br />99/0P/!P
<br />1-010
<br />/OR
<br />H1N]
<br />Psyznoetlwadonal seruie.per li99fIP
<br />99/OPHJN]
<br />TG
<br />Ps%nuetlea,0enal rervke, pmismrnusn
<br />p
<br />11g5
<br />1].33
<br />1]AS
<br />NPHL-
<br />TG
<br />Ps%Nnede.nNnnal rer.reper is mmux•
<br />9911P
<br />11g5
<br />l],85x]as
<br />99loPnp
<br />1.
<br />1.23N3bls
<br />Sewlollmdcr--1 rmax. per 15 minmes
<br />10
<br />alorcmdm 4aaMenrsernae, per l5 minutes
<br />211.11,
<br />].2J
<br />rMOFg
<br />Sevlaiabgmdtt norm ¢. per li minutes
<br />999yNP
<br />1.2i
<br />prrd
<br />o-xanP
<br />JSAs9
<br />lso.s9
<br />Jsgn
<br />N3x}1
<br />MI-1-11h a,IryMnse urv'kn. m
<br />0.mfoP
<br />]50.59
<br />-
<br />21A991IP
<br />]5A59
<br />15p. s9
<br />]50.59
<br />xigSF
<br />r111-11 ,urv'kn, pndiem
<br />599fOP
<br />L50.59
<br />59
<br />o-30(Ip
<br />M9
<br />20.9
<br />N1033
<br />Mdtuylemk MesapY for lu.snlles, peri5 minute
<br />o-y9(W
<br />10.9
<br />20.4
<br />]s993nP
<br />10.9
<br />20.4
<br />1-3
<br />Muhhytemk µempYforjnemlex pas l5mnun
<br />11-999l4P
<br />10.9
<br />20.9
<br />G9
<br />A9
<br />1-3
<br />TG
<br />MUNuyxmk Mempy fw juveniles, per l5 minwm
<br />o-2W4p
<br />10.9
<br />10.9
<br />'P.999IIP
<br />2m10,9
<br />H1Gil
<br />TG
<br />Mdµ%Irmk µa,py for fusenJea, per is miaares
<br />2I99910P
<br />2A9
<br />l0.9
<br />0,9
<br />andlere[Fer µu;haarm=n[preal+m.nn dkm
<br />41pdP
<br />l42
<br />14,1
<br />N2036
<br />Altnnd mtl/scorner rnugttearment pa5r+m. per diem
<br />0.LONP
<br />19.E
<br />19.E
<br />19.2
<br />and(ue e[Fer dra; Heatmmt we9•+m.pn dkm
<br />-1.1
<br />14.2
<br />NItr36
<br />M ond,nJ/arorM1er sno;teawneat p.ogr+m-p=r diem
<br />21WAIOP
<br />14E
<br />l42
<br />Ie.Z
<br />and(xr e[M1m drug Haaanm[ p.eg.+m. pr• diem
<br />PIRA,
<br />11.2
<br />lµ
<br />Mmhel and/a. elher dire tee
<br />0.2wOe
<br />1A
<br />111
<br />142
<br />x}4}4
<br />NA
<br />Isodolmd(m ofhtt do trnlmcn]wogram. per tlicm
<br />21-99J11P
<br />142
<br />14£
<br />Sdi
<br />HA
<br />xhel and/a. ether dr f
<br />21A99104
<br />Id.2
<br />14,2
<br />SA.2
<br />-I-.
<br />lµ
<br />Alsehol andle. oihcr dins I.P.-palm. per tlicm
<br />-up
<br />.,i
<br />14.3
<br />--11.1
<br />NO
<br />Mmhd+nd/a. efherdemtwrment paiiram, per aiem
<br />0.20/trP
<br />11.2
<br />19,1
<br />14.E
<br />e}436
<br />91,
<br />almdol md(m Ithrr ding r,nlmrn t nogam. per diem
<br />-99IIP
<br />P42
<br />14£
<br />F4.2
<br />antllm other armueasmen[pxgam, per diem
<br />il P'S""
<br />141
<br />FI.2
<br />N2036
<br />IF
<br />Alcohol antl/or orM1er em;uraunent pog,m. per dlem
<br />4}4lrp
<br />SI.2
<br />IS
<br />..IF
<br />IFMmhxl
<br />analxr xµmaru;teearment wxgam, Pe. mem
<br />p3Glpp
<br />t42
<br />]A.l
<br />N2636
<br />IF
<br />Alsonol antl/or oiM1er tlrv; veaunent pegam. per dlem
<br />F3-99yIP
<br />1+,2
<br />19.2
<br />141
<br />.1
<br />antllur other dire; trearmm[wxyam, per dlem
<br />9ggfov
<br />1q.2
<br />]63
<br />105I1
<br />BxPreoorphlce.oraL2mg
<br />4999A1n1lIP
<br />0.Ix
<br />Nw pmw
<br />Nat Pried
<br />ne.grlrk, ma{ x mx
<br />vwT/op
<br />Nor P«ee
<br />1.12
<br />8uprennrplrlcelnalo+me, eraL lesstN,n a. meal lx 3m b
<br />0.999JMT/IP
<br />A51
<br />Igor 1".
<br />451
<br />ne+plricefuab+me eml, rns µas• e. emr91 l0 3 m;buprmwphine
<br />9MAT10P
<br />Nol Pied
<br />105I3
<br />9apemmpnnre/nxlamnq ma4 m=+me rh+a3mx. but less µan urmua[M6rng huprmeephc=
<br />0.9995µT/IP
<br />lbJ
<br />IJw 4rien
<br />F.g3
<br />beelnale=eee, sea{ p=as:e rh+n 3 mx, bet Inc tW n orequal l05 mg haprmorphine
<br />999MFT/OP
<br />Not Aietl
<br />Itr5]4
<br />Naprmo.pLaF/n>Iaemgara{M=+ree ih+n4m,bnt lnstban wequa[tx lOms'daPeme.pmnr
<br />0.999MATlIP
<br />A69
<br />Nnrhkea
<br />0.H
<br />leKfnalereec,m+{ gr=merµm 6mg. but lass 1-.1e 11. lb-9 hapeeeo..N-
<br />.-TI.,
<br />[Rkad
<br />N¢t Pr'red
<br />hoe/nabmneoral, ®eater Man 1pmgWwenuphn=
<br />--tA,
<br />1a9
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<br />xer Nk,1
<br />].89
<br />165I5
<br />baPrcnwphlrclnalor:one. oral. Peaxr Man lOm4 WPennlirne
<br />4999MA1n]P
<br />1.84
<br />Nor Pried
<br />Nel Prred
<br />nabmne HM
<br />999MAtnp
<br />9.30
<br />9.51
<br />12330
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<br />D999Matn}P
<br />9,m
<br />9, 14
<br />9.J4
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<br />I.11
<br />,.,1
<br />12311
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<br />U999MATI,
<br />I 11l
<br />In
<br />MATNP
<br />N-m.
<br />It3FG
<br />Hahee,one, depot loem
<br />0999A61T10P
<br />I.J
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<br />Nos39Ped
<br />1,1
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<br />4MGMATIOp
<br />1-
<br />1-0
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<br />t.V'homcNabmnce mxnasrlsprap. cllMhe ]1L2022 repl-1 G191e
<br />MATIrP
<br />5;9q
<br />5A9a
<br />59.961-4
<br />TPi-Taie-hens
<br />Nabmneg mpmrrlsp.aP, elkrtiee lll/IDlt replaeaymofx
<br />p9991M1/tlP
<br />59,sd
<br />39.94
<br />S 4
<br />M0291
<br />-d i9 Vawme Home Atlmin
<br />OiNF,
<br />35
<br />Nol Prketl
<br />Ne19R ed
<br />PlWPI,
<br />Nnt Prketl
<br />JS
<br />MOHII
<br />(wM39 Yawrsm Home Wmin
<br />21999/IP
<br />JS
<br />Not W'ree
<br />94JAOP
<br />eed
<br />Not PrkN
<br />lG
<br />A301q
<br />TekhealµawlgmJng slx bdlty fee
<br />0.20AP
<br />11.6J
<br />2A.63
<br />MEl
<br />g10F4
<br />0.lOpP
<br />21.63
<br />24GJ
<br />21114
<br />Iekbealure i5buurrg 3ltebWlyree
<br />21-111
<br />}d.6i
<br />24.61
<br />Z453
<br />03014
<br />le 6h 1hprier lies six N.I-
<br />ZI-99914P
<br />SA,43
<br />110
<br />eomnaenxreaedmk•ase l5uhlwadel,Insµan acme+lm lW mg
<br />MATdp
<br />Pried
<br />196L56
<br />AYAI
<br />fnjecdon. buprenorpninenxrrtlednekase lSuhlwaeel.lns µaemmual VP I.mg
<br />4999MATl4P
<br />1461.56
<br />IJot Pried
<br />Not vetted
<br />tJ994
<br />ass l5uhtocadq, y=aln lWn100my
<br />Mai(1p
<br />Pried
<br />peied
<br />196156
<br />p 12
<br />Injwdon; bumenorphinrnxMetlneka»ISuhlocadel,gearertNnlpOmg
<br />0999MAT/OP
<br />19 H
<br />Not Pried
<br />pried
<br />�s75,3
<br />01wiP
<br />S9121
<br />e-. Ge., In lee Home, P
<br />u10/0P
<br />IS.J
<br />noit
<br />751153
<br />591£5
<br />h.S'u in lH=t "p
<br />99gnp
<br />153
<br />15.3
<br />]S.3
<br />59125
<br />is lhetbme,P
<br />?, PISPV p
<br />ml
<br />754
<br />]5,3
<br />S9m4
<br />P+«nl cduraden.nol orberwkerbrdgrtl. nonphyrkim prwldm,gwep per mswu
<br />42wIP
<br />].36
<br />1.16
<br />].S4
<br />Bent educatiae, nx[xµerwiseabavlim,nmphniian prwi�.,swwper uxsbn
<br />o-xplGp
<br />].35
<br />59mG
<br />gdrnt rduradon. nol onc�rwbe sNr Ilkml. nonghyskian prmvkr,8map tm*s+ssan
<br />11999111
<br />131
<br />1,31
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<br />111j-
<br />J,3lP
<br />17gd6
<br />TG
<br />P,cenledusadon,nw otlmrwrcecbsdfrtl,nm-phni in prwiµx, grwp, persnslen
<br />0.2wlP
<br />I-
<br />].i6
<br />e.phni4n PrwiM.6rouP, per res3nn
<br />.,Fmp
<br />7.3E
<br />1.3u
<br />59m6
<br />IG
<br />I•,umledat,den, eredmn.recWrifed,em phr+i
<br />21-0 A,
<br />IAG
<br />L36
<br />1.}6
<br />39m4
<br />eel eµ<rwue=brsdmd,nm-ohniian provlder.gre p,pN rrdan
<br />7]-995/Op
<br />I134
<br />I.3b
<br />7.36
<br />IIg
<br />set Psxhl.
<br />0.1tlnP
<br />96d
<br />9AA
<br />1909
<br />59980
<br />el
<br />oatp9tint P]Yshla
<br />424I4P
<br />1949
<br />19G4
<br />l9fid
<br />Ouµanent Ps%ba
<br />dip
<br />1944
<br />19fid
<br />Mao
<br />HIP
<br />Intemiee Oumadent Ps%M1fa
<br />21994fOP
<br />F9fi9
<br />19fi9
<br />µalpanent Ps%M1b
<br />0.NYIP
<br />3169
<br />3).G9
<br />M+80
<br />Me IN— Ps%boa
<br />'10for
<br />i}.69
<br />31.69
<br />S-n
<br />11xylP
<br />1 3'.
<br />37.69
<br />3Y.69
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<br />be µrtp,cent Vryshu
<br />13A99211P
<br />1149
<br />59m0
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<br />-we,
<br />i 3].69
<br />3].69
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