Washington Administrative Code

All services rendered must be in accordance with the medical aid rules, fee schedules, and department policy. The department or self-insurer may reject bills for services rendered in violation of these rules. Workers may not be billed for services rendered in violation of these r…

Adjustments to the conversion factors for providers and services covered by the fee schedules and by department policy may occur annually following prior public hearings.Such adjustments will be based on the estimated increase/decrease in the state's average wage for the current …

(Effective until July 1, 2026)(1) Conversion factors are used to calculate payment levels for services reimbursed under the Washington resource based relative value scale (RBRVS), and for anesthesia services payable with base and time units.(2) Washington RBRVS services have a co…

(1) Acceptance and filling of a prescription for a worker entitled to benefits under the industrial insurance law, constitutes acceptance of the department's rules and fees.(2) When there is questionable eligibility, (i.e., no claim number, prescription is for medication other th…

(1) The department or self-insurer will pay for medications or supplies dispensed for the treatment of conditions resulting from an industrial injury and/or conditions which are retarding the recovery from the industrial injury, for which the department or self-insurer has accept…

In addition to the billing procedures described in WAC 296-20-125 and in department policy the current national drug code number for each prescribed drug, followed by the average wholesale price to the pharmacy must be entered on each prescription. The department's statement for …

(1) Pharmacies may bill the department for initial prescription drugs prior to claim acceptance upon the presentation to the pharmacy of a state fund identification card or a copy of the Report of Industrial Injury or Occupational Disease with a valid claim number.(2) The departm…

Permanent partial disability is any anatomic or functional abnormality or loss after maximum medical improvement (MMI) has been achieved. At MMI, the worker's condition is determined to be stable or nonprogressive at the time the evaluation is made. A permanent partial disability…

Under Title 51 RCW, there are two types of permanent partial disabilities.(1) Specified disabilities are listed in RCW 51.32.080 (1)(a). They are limited to amputation or loss of function of extremities, loss of hearing or loss of vision.(2) Unspecified disabilities include, but …

(1) Specified disabilities are rated in one of two ways:(a) Impairment due to amputation, total loss of hearing, and total loss of vision are rated according to RCW 51.32.080;(b) Impairment for the loss of function of extremities, as well as partial loss of hearing or vision, is …

The categories used to rate unspecified disabilities incorporate the worker's subjective complaints. Similarly, the organ and body system ratings in the AMA Guides to the Evaluation of Permanent Impairment incorporate the worker's subjective complaints. A worker's subjective comp…

(1) The department of labor and industries has promulgated the following rules and categories to provide a comprehensive system of classifying unspecified permanent partial disabilities in the proportion they reasonably bear to total bodily impairment. The department's objectives…

These general rules must be followed by providers who perform examinations or evaluations of permanent bodily impairment.(1) Impairment rating examinations shall be performed only by attending providers and consultants currently licensed in both medicine and surgery (including os…

The following table provides guidance regarding the rating systems generally used. These rating systems or others adopted through department policies should be used to conduct an impairment rating.Overview of Systems for Rating ImpairmentRating SystemUsed for These ConditionsForm…

(1) Workers can bring an adult friend or family member to the impairment rating examination to provide comfort and reassurance. The accompanying person may attend the physical examination but may not attend a psychiatric examination.(2) The accompanying person cannot be compensat…

The use of recording equipment of any kind by the worker or accompanying person is not allowed.[Statutory Authority: RCW 51.04.020, 51.04.030, and 51.36.010. WSR 25-11-071, s 296-20-2030, filed 5/20/25, effective 7/1/25. Statutory Authority: RCW 51.32.055, 51.32.112, 51.32.114, 5…

(1) Evaluations of permanent bodily impairment using categories require uniformity in procedure and terminology. The following rules have been enacted to produce this uniformity and shall apply to all evaluations of permanent impairment of an unspecified nature.(a) Gradations of …

(1) Rules for evaluation of cervical and cervico-dorsal impairments are as follows:(a) Muscle spasm or involuntary guarding, bony or fibrous fusion, any arthritic condition, internal fixation devices or other physical finding shall be considered, in selecting the appropriate cate…

(1) No objective clinical findings are present. Subjective complaints may be present or absent.(2) Mild cervico-dorsal impairment, with objective clinical findings of such impairment with neck rigidity substantiated by X-ray findings of loss of anterior curve, without significant…

(1) Rules for evaluation of permanent dorsal area impairments are as follows:(a) Muscle spasm or involuntary guarding, bony or fibrous fusion, any arthritic condition, internal fixation devices or other physical finding shall be considered, in selection of the appropriate categor…

(1) No objective clinical findings are present. Subjective complaints may be present or absent.(2) Mild or moderate dorsal impairment, with objective clinical findings of such impairment, without significant objective neurological findings, with or without X-ray changes of narrow…

(1) Rules for evaluation of permanent dorso-lumbar and lumbosacral impairments are as follows:(a) Muscle spasm or involuntary guarding, bony or fibrous fusion, any arthritic condition, internal fixation devices or other physical finding shall be considered, in selecting the appro…

(1) No objective clinical findings. Subjective complaints and/or sensory losses may be present or absent.(2) Mild low back impairment, with mild intermittent objective clinical findings of such impairment but no significant X-ray findings and no significant objective motor loss. …

(1) Rules for impairment of the pelvis:(a) All of these categories include the presence of complaints of whatever degree.(b) Categories 2, 5, 6 and 7 describe separate entities and more than one may be selected when appropriate. Category 9 includes the findings described in Categ…

(1) Healed pelvic fractures without displacement, without residuals; healed fractures with displacement without residuals, of: Single ramus, bilateral rami, ilium, innominate or coccyx; or healed fracture of single rami with displacement with deformity and residuals.(2) Healed fr…

(1) Rules for evaluation of convulsive neurological impairments:(a) The description of Categories 2, 3 and 4 include the presence of complaints of whatever degree.[Order 74-32, § 296-20-310, filed 6/21/74, effective 10/1/74.]

(1) No electroencephalogram findings of convulsive neurological disorder. Subjective complaints may be present or absent.(2) Electroencephalogram findings of convulsive neurological disorder, but on appropriate medication there are no seizures.(3) Electroencephalogram findings of…

Rules for evaluation of permanent impairment of mental health:(1) Mental illness means malfunction of the psychic apparatus that significantly interferes with ordinary living.(2) Each person has a pattern of adjustment to life. The pattern of adjustment before the industrial inju…

(1) Nervousness, irritability, worry or lack of motivation following an injury and commensurate with it and/or other situational responses to injury that do not alter significantly the life adjustment of the patient may be present.(2) Any and all permanent worsenings of preexisti…

(1) Rule for evaluation of permanent cardiac impairments:(a) Classification of impairment using the following categories shall be based upon a carefully obtained history, thorough physical examination and the use of appropriate laboratory aids.[Order 74-32, § 296-20-350, filed 6/…

(1) No objective findings are present. Subjective complaints may be present or absent.(2) Objective findings of mild organic heart disease but no signs of congestive heart failure. No medically appropriate symptoms produced by prolonged exertion or intensive effort or marked emot…

(1) Rules for evaluation of permanent respiratory impairments:(a) Definitions.(i) "FEV1" means the forced expiratory volume in 1 second as measured by a spirometric test performed as described in the most current American Thoracic Society Statement on Standardization of Spirometr…

(1) The FVC and FEV1 are greater than or equal to eighty percent of predicted normal for the person's age, gender, and height. The FEV1/FVC ratio is greater than or equal to .70. Subjective complaints may be present or absent. If exercise testing is done, the maximum oxygen consu…

(1) "Normal" bronchial reactivity is demonstrated by an insignificant (less than twenty percent) fall from baseline FEV1 at test doses of histamine or methacholine, up to 16 mg/ml (continuous inhalation method) or up to 160 breath units (cumulative, repeated deep breath technique…

(1) Rule for evaluation of permanent air passage impairments:(a) Categories 2, 3, 4 and 5 include the presence of complaints of whatever degree.[Order 74-32, § 296-20-390, filed 6/21/74, effective 10/1/74.]

(1) No objective findings are present. Subjective complaints may be present or absent.(2) Objective findings of one or more of the following air passage defects: Partial obstruction of oropharynx, laryngopharynx, larynx, trachea, bronchi, complete obstruction of nasopharynx or of…

(1) Rules for evaluation of permanent air passage impairments due to nasal septum perforation.(a) These categories, if appropriate, are to be used in addition to the categories of permanent air passage impairment.(b) Categories 1 and 2 include complaints of whatever degree.[Order…

(1) Perforation or perforations posterior to the cartilaginous septum.(2) Perforation or perforations through or anterior to the cartilaginous septum.[Order 74-32, § 296-20-420, filed 6/21/74, effective 10/1/74.]

(1) Rule for evaluation of permanent loss of taste and smell.(a) If the person being examined can detect any odor or taste, even though it cannot be named, no category shall be assigned.[Order 74-32, § 296-20-430, filed 6/21/74, effective 10/1/74.]

(1) Loss of sense of taste.(2) Loss of sense of smell.[Order 74-32, § 296-20-440, filed 6/21/74, effective 10/1/74.]

(1) Rules for evaluation of permanent speech impairments.(a) The physician making an examination for evaluation of permanent speech impairment should have normal hearing and the examination should be conducted in a reasonably quiet office which approximates the noise level condit…

(1) No objective findings of significant speech impairment are present. Subjective complaints may be present or absent.(2) Can produce speech of sufficient audibility, intelligibility and functional efficiency for most everyday needs, although this may require effort and occasion…

(1) Rules for evaluation of permanent skin impairments.(a) Evaluation of permanent impairment of the skin shall be based upon actual loss of function and cosmetic factors shall not be considered.(b) Categories 2, 3, 4, 5 and 6 include the presence of complaints of whatever degree…

(1) Objective findings of skin disorder may be present or absent but there is no or minimal limitation in daily activities. Subjective complaints may be present or absent.(2) Objective findings of skin disorder are present and there is discomfort and minimal limitation in the per…

(1) Rule for evaluation of permanent impairments of the upper digestive tract, stomach, esophagus or pancreas.(a) Categories 2, 3, 4 and 5 include complaints of whatever degree.[Order 74-32, § 296-20-490, filed 6/21/74, effective 10/1/74.]

(1) No objective findings are present. Subjective complaints may be present or absent.(2) There are objective findings of digestive tract impairment but no anatomic loss or alteration, continuous treatment is not required and weight can be maintained at the medically appropriate …

(1) Rule for evaluation of permanent lower digestive tract impairments.(a) Categories 2, 3 and 4 include the presence of complaints of whatever degree.[Order 74-32, § 296-20-510, filed 6/21/74, effective 10/1/74.]

(1) No objective findings of impairment of lower digestive tract. Subjective complaints may be present or absent.(2) The objective findings of lower digestive tract impairment are infrequent and of brief duration, and there is limitation of activities, but special diet or medicat…

(1) Rule for evaluation of permanent impairment of anal function.(a) Categories 2, 3 and 4 include the presence of complaints of whatever degree.[Order 74-32, § 296-20-530, filed 6/21/74, effective 10/1/74.]

(1) No objective findings of impairment of anal function. Subjective complaints may be present or absent.(2) There are objective findings of mild organic disease, anatomic loss or alteration with loss of anal function and mild incontinence involving gas and/or liquid stool.(3) Th…