1. (1) The medicaid agency pays physicians or qualified health care professionals (QHCPs) for critical care physician-related services to critically ill or injured clients as follows:

   1. (a) More than one physician or QHCP if the services provided involve different specialties; or
   2. (b) Only one physician or QHCP for services provided in the emergency room.

2. (2) The agency pays preoperative and postoperative critical care in addition to the global surgical package when all the following apply:

   1. (a) The client is critically ill or injured and the physician or QHCP is engaged in work directly related to the client's care;
   2. (b) The critical care is unrelated to the specific anatomic injury or general surgical procedure performed and goes beyond the normal procedure; and
   3. (c) The provider uses an appropriate modifier when billing the agency if appropriate.

3. (3) The agency does not pay separately for the following services performed by the provider when delivering critical care during a critical care period:

   1. (a) Collection and interpretation of physiologic data; (e.g., electrocardiogram, blood pressure, hematologic data, etc.);
   2. (b) Blood draw for a specimen;
   3. (c) Blood gases;
   4. (d) Cardiac output measurement;
   5. (e) Chest X-rays;
   6. (f) Gastric intubation;
   7. (g) Pulse oximetry;
   8. (h) Temporary transcutaneous pacing;
   9. (i) Vascular access procedures; and
   10. (j) Ventilator management.

[Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 25-18-049, s 182-531-0450, filed 8/27/25, effective 9/27/25. WSR 11-14-075, recodified as § 182-531-0450, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090. WSR 10-19-057, § 388-531-0450, filed 9/14/10, effective 10/15/10. Statutory Authority: RCW 74.08.090, 74.09.520. WSR 01-01-012, § 388-531-0450, filed 12/6/00, effective 1/6/01.]