1. (1) The health care professionals and health care entities listed in WAC 182-502-0002 and enrolled with the medicaid agency can bill for physician-related and health care professional services that are within their scope of practice.

2. (2) The agency pays for services provided by, or in conjunction with, a resident physician when:

   1. (a) The services are billed under the teaching hospital's national provider identifier (NPI) or the supervising physician's NPI;
   2. (b) The servicing provider is identified on the claim under the teaching or resident physician's NPI; and
   3. (c) The services are provided and billed according to this chapter and chapters 182-501 and 182-502 WAC.
3. (3) The agency does not pay for services performed by any of the health care professionals listed in WAC 182-502-0003.

4. (4) The agency pays eligible providers for physician-related services and health care professional services if those services are mandated by, and provided to clients who are eligible for, one of the following:

   1. (a) The early periodic screening, diagnosis, and treatment (EPSDT) program, see chapter 182-534 WAC;
   2. (b) A Washington apple health program for qualified medicare beneficiaries (QMB); or
   3. (c) A waiver program.

[Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 25-21-142, s 182-531-0250, filed 10/21/25, effective 11/21/25; WSR 23-21-061, § 182-531-0250, filed 10/12/23, effective 11/12/23; WSR 15-17-066, § 182-531-0250, filed 8/14/15, effective 9/14/15; WSR 15-03-041, § 182-531-0250, filed 1/12/15, effective 2/12/15. WSR 11-14-075, recodified as § 182-531-0250, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090. WSR 11-14-055, § 388-531-0250, filed 6/29/11, effective 7/30/11. Statutory Authority: RCW 74.09.521. WSR 08-12-030, § 388-531-0250, filed 5/29/08, effective 7/1/08. Statutory Authority: RCW 74.08.090, 74.09.520. WSR 05-12-022, § 388-531-0250, filed 5/20/05, effective 6/20/05; WSR 01-01-012, § 388-531-0250, filed 12/6/00, effective 1/6/01.]