Apple Health Fee Schedule: Washington Medicaid Rates List

Ask ten people what the “Apple Health fee schedule” actually is, and you’ll get ten different half-answers. That’s not their fault. Washington’s Health Care Authority (HCA) doesn’t publish one master document with every Medicaid rate in it — it publishes dozens, split across programs, provider types, and effective dates.

There’s no universal Apple Health fee schedule sitting in one PDF. HCA maintains separate schedules for physician services, dental care, mental health, outpatient hospitals, EPSDT, medical equipment, hearing services, and a long list of other programs.

Here’s the part patients get wrong most often: a number on a fee schedule is not what you owe. It’s a reimbursement reference — a description of how Washington Apple Health calculates payment to a provider. What you actually owe, if anything, depends on your specific program, whether you’re in managed care, service authorization rules, and a handful of other variables. If eligibility is part of what’s confusing you, how Medicaid income limits determine what you qualify for is worth understanding before you go rate-hunting.

What Is the Apple Health Fee Schedule?

Think of it as a list of reimbursement information Washington Medicaid uses for specific covered services. Nothing more mysterious than that.
A given schedule typically identifies:

Procedure or billing code
Service description
Reimbursement amount
Units
Effective date
Modifiers or billing indicators
Applicable service or provider category

Physician services generally use CPT codes. Other categories lean on HCPCS, NDC, or different coding systems entirely — which is one reason a single search rarely gives you the full picture.

Treat the published rate as a Medicaid payment reference, not a consumer price tag. Washington’s own rules make clear that Medicaid payment hinges on program coverage, medical necessity, authorization when it’s required, correct billing, and an enrolled provider. The agency reimburses at the usual and customary charge or the maximum allowable fee it has established, whichever comes out lower.

Apple Health Fee Schedule 2026

There isn’t a single 2026 Apple Health fee schedule. There are several, running on their own timelines.
HCA’s official publications show multiple 2026 effective dates depending on the program. Physician services alone have fee schedules effective January 1, April 1, and July 1, 2026.

Right now, in the July–September 2026 window, the July 1, 2026 version matters most for physician services. But that’s not a universal rule — always match the schedule to the service in question. If you’re comparing Washington’s approach to how other states structure their rates, this state-by-state Medicaid fee schedule comparison lays out the differences.

Major Apple Health Fee Schedules

Schedule	What it generally covers	Current 2026 example
Physician services	Professional medical services	July 1, 2026
Dental	Dental-related services	July 1, 2026
EPSDT	Children’s preventive and medically necessary services	July 1, 2026
Mental health	Behavioral and mental health services	Current HCA schedule
Outpatient hospital	Hospital outpatient services	July 1, 2026 billing materials
Medical equipment	Medical equipment and supplies	Applicable current schedule
Hearing	Hearing services and hardware	July 1, 2026
RHC	Rural Health Clinic encounter rates	July 1, 2026
HCA’s current directory holds plenty more specialty schedules and billing guides beyond this list.

Why Are There Different Fee Schedule Dates?

Because rates move during the year, and using an outdated version gives you a wrong number. Simple as that.
HCA’s physician schedules split into January 1, April 1, and July 1 versions for 2026 alone. Other programs update on entirely different calendars.

Match the schedule to the date the service was actually provided. Don’t assume a CPT code carries the same reimbursement all year — that assumption is where most lookup errors start.

Apple Health Fee Schedules by Service

Physician Services

This is the fee schedule most people are actually hunting for when they search “Washington Medicaid rates” or “Apple Health CPT reimbursement.”

HCA publishes a Physician-Related Services Billing Guide alongside the physician fee schedules themselves. The July 1, 2026 version of that billing guide is the current one for this period.

Dental Services

The dental fee schedule covers services under whichever Apple Health dental program applies to you.
HCA lists a dental-related services billing guide effective July 1, 2026, plus earlier versions for reference. Make sure you’re checking the right dental program and effective date — a general medical fee schedule won’t help you here.

Mental Health and Behavioral Health

Payment arrangements for behavioral health can look completely different depending on how the service is structured.

Start by figuring out whether your service runs through your managed care organization (MCO), a separate Apple Health behavioral health arrangement, or straight Fee-for-Service (FFS). That answer determines who’s actually on the hook for payment.

Hospital and OPPS Services

A hospital visit doesn’t get paid like a physician office visit. Different rules entirely.

HCA maintains its own outpatient hospital billing materials, including a July 1, 2026 Outpatient Hospital Services Billing Guide. Searching only for a physician CPT rate won’t answer a question about outpatient hospital care — it’s a separate track.

EPSDT and Pediatric Services

EPSDT covers Early and Periodic Screening, Diagnostic and Treatment services for eligible children. HCA’s EPSDT fee schedule is effective July 1, 2026.
Kids’ services often follow different rules than adult services. Check the specific billing guide rather than assuming standard coverage rules carry over.

Medical Equipment and Supplies

Equipment and supplies run on their own reimbursement rules. Don’t compare a medical equipment rate against a physician or hospital rate — the payment methodology isn’t the same, and the comparison won’t tell you anything useful.

How to Look Up an Apple Health Rate

Want to find a specific rate yourself? Here’s the sequence that actually works:

Go to the Washington HCA Provider Billing Guides and Fee Schedules page.
Find the service category matching your care.
Select the fee schedule with the correct effective date.
Open the schedule.
Search for the CPT, HCPCS, or applicable procedure code.
Check the listed rate, unit, modifiers, and notes.
Determine whether the claim runs through FFS or managed care.
HCA’s official directory organizes everything by service and effective period, which makes it the only starting point worth using.

What Are CPT and HCPCS Codes?

CPT codes are standardized identifiers for medical procedures and professional services. HCPCS codes cover health care services, supplies, equipment, and related items outside the standard CPT set.

A code from a medical bill or explanation of benefits gives you the starting thread to pull on an Apple Health fee schedule. Finding that code, though, doesn’t prove your specific service will get paid. Coverage, medical necessity, authorization, provider enrollment, and program eligibility all still matter — Washington’s payment rules spell these conditions out explicitly. Eligibility itself often traces back to income, so understanding current Medicaid income limits can clarify whether the coverage question even applies to you.

Does the Apple Health Fee Schedule Tell Me What I Pay?

No. And this is the single most important thing to walk away with.

A published Apple Health reimbursement rate is not your patient cost. Picture the process like this:
Published rate → provider claim → FFS or managed-care payment → applicable patient responsibility

A provider submits a claim tied to a procedure code, but what actually gets paid depends on the coverage arrangement in place. Washington’s rules separate client financial obligations from what the Medicaid agency itself pays.

Got a bill that doesn’t look right? Compare it against your Apple Health coverage information and call your health plan or HCA directly. Don’t assume the fee-schedule number is your personal bill — it usually isn’t.

Apple Health FFS vs Managed Care

Washington runs both Fee-for-Service and managed-care arrangements under Apple Health, and they don’t work the same way.

Under FFS, Apple Health pays an enrolled provider directly for covered services according to the applicable rules. Under managed care, an MCO carries responsibility for services included in its state contract — and Washington’s rules are explicit that the Medicaid agency won’t make an FFS payment for something already covered under an MCO contract.

So two Apple Health members can have coverage that looks similar on paper but gets processed through entirely different payment pathways.

How Do I Know Which One Applies?

Check your Apple Health coverage information first. Are you enrolled in a managed-care plan?

If yes, contact that plan directly about covered services, provider networks, and claims. If your service runs through FFS instead, the HCA fee schedule and ProviderOne billing information are your more direct references.

Why an Apple Health Rate May Not Match a Medical Bill

Several things can cause a published rate and an actual bill to diverge:

Different effective dates. A January schedule doesn’t apply to a July service.
Different service categories. Physician, hospital, dental, and equipment services each run on their own schedules.
Managed care. Your MCO — not direct FFS — may be responsible for the service.
Prior authorization. Some services simply won’t get paid without it first.
Provider enrollment. Washington requires providers to meet specific enrollment standards before Medicaid pays them.
Payment methodology. FQHCs and RHCs, for instance, use encounter-rate methodologies — a different approach entirely from standard professional service payment.

How Often Does Washington Update Apple Health Rates?

There’s no single answer, because there’s no single update calendar.

Physician fee schedules see multiple 2026 versions. Some specialty schedules stick to one annual July 1 update. Checking the effective date matters just as much as checking the procedure code — arguably more.

Common Apple Health Fee Schedule Mistakes

Watch for these:

Using a 2025 schedule for a 2026 service
Looking at the wrong service category
Treating the reimbursement amount as the patient’s bill
Ignoring managed-care enrollment
Checking a CPT code without reading its notes
Assuming every provider receives the same payment
Ignoring prior authorization requirements
Using an unofficial rate website instead of HCA
Assuming a listed rate guarantees coverage

Program rules shift too — including work requirement changes now spreading across Medicaid programs nationally — so it’s worth staying current on eligibility rules, not just rates.

Where to Find the Official Apple Health Fee Schedule

The Washington State Health Care Authority is the authoritative source for Apple Health provider billing guides and fee schedules. Its current directory spans 2026 materials across physician, dental, EPSDT, hearing, habilitative, outpatient hospital, pregnancy-related, pharmacy, RHC, and other service categories.

For the legal backbone behind these payment rules, Washington’s administrative code fills in the gaps. WAC 182-502-0100 covers the general conditions of Medicaid payment — coverage, medical necessity, authorization, provider enrollment, billing requirements, and how FFS and managed-care responsibility get divided.

Official Resources

FAQs

What is the Apple Health fee schedule?

It’s Washington Medicaid’s published reimbursement information for covered services, split by service category, program, provider type, and effective date.

Is there one Apple Health fee schedule?

No. Physician, dental, hospital, EPSDT, mental health, equipment, hearing — each can have its own separate schedule.

What are the Apple Health rates for 2026?

There’s no single 2026 rate. It depends on the service, the code, the schedule version, the effective date, and the payment methodology involved.

How do I find an Apple Health CPT code rate?

Find the right HCA fee schedule, pick the version covering your service date, then search the CPT code and check the rate, unit, modifiers, and notes.

Does the Apple Health fee schedule show what I have to pay?

No. The published amount isn’t automatically your responsibility — that depends on your coverage and the applicable Apple Health rules.

What is Apple Health FFS?

Fee-for-Service. Medicaid pays an enrolled provider directly for eligible services under FFS rules.

Do Apple Health managed-care plans use the same fee schedule?

Not necessarily. Services under an MCO’s contract are generally the MCO’s payment responsibility, not a direct FFS payment.

Does Apple Health cover every service listed on a fee schedule?

Not automatically. Coverage still depends on medical necessity, authorization, provider enrollment, and other billing requirements.

How often does Washington update Apple Health fee schedules?

It varies by program — some update multiple times a year, others less often. Check HCA for the version matching your service date.

Is Apple Health the same as Medicaid?

Yes. Apple Health is what Washington calls its Medicaid program and related public health coverage system.

Conclusion

At the end of the day, there’s no shortcut around checking the actual date and category of your service. The Apple Health Fee Schedule 2026 isn’t a single price list you can skim once and trust forever — it’s a moving set of documents that HCA updates on its own terms. Find the right schedule, confirm whether you’re in FFS or managed care, and never assume the number on a page is the number on your bill. That habit alone will save you more confusion than anything else in this guide.

Disclaimer: This article is for general informational purposes and is not medical, legal, billing, or financial advice. Apple Health rules and fee schedules can change, so always confirm current rates, coverage, and patient responsibility with the Washington State Health Care Authority or your Apple Health plan.