Facility Fee Reporting


Hospital Facility Fees

In accordance with RCW 70.01.040, all hospitals with off-campus provider-based clinics that bill a separate facility fee shall report information annually to the Department of Health. The reports are collected at the end of the fiscal year.

20212020 | 2019 | 2018 | 2017


Hospitals shall submit the number of off-campus provider-based clinics owned or operated by the hospital that charge or bill a separate facility fee; the number of patient visits at each off-campus, provider-based clinic for which a facility fee was charged or billed for the year; the revenue received by the hospital for the year by means of facility fees at each off-campus, provider-based clinic; and the range of allowable facility fees paid by public or private payers at each off-campus, provider-based clinic using DOH Form 346-094 Hospital Owned Provider-Based Clinic Facility Fee Reporting (Excel).

Please submit the form either by mail or email to: Washington State Department of Health, Community Health Systems, MS: 47853, Olympia, WA 98504, email: hos@doh.wa.gov.

Due dates

Report the data along with the year-end financial reports submitted to the Department of Health pursuant to RCW 43.70.052. This reporting date is 120 days after the end of the hospital's fiscal year.


Hospitals shall use the following definitions to complete the Hospital Owned Provider-Based Clinic Facility Fee Reporting form (Excel):

RCW 70.01.040 (5)

(a)"Facility fee" means any separate charge or billing by a provider-based clinic in addition to a professional fee for physicians' services that is intended to cover building, electronic medical records systems, billing, and other administrative and operational expenses.

(b)"Provider-based clinic" means the site of an off-campus clinic or provider office that is owned by a hospital licensed under chapter 70.41 RCW or a health system that operates one or more hospitals licensed under chapter 70.41 RCW, is licensed as part of the hospital, and is primarily engaged in providing diagnostic and therapeutic care including medical history, physical examinations, assessment of health status, and treatment monitoring. This does not include clinics exclusively designed for and providing laboratory, x- ray, testing, therapy, pharmacy, or educational services and does not include facilities designated as rural health clinics.

For more information

Frequently Asked Questions about Hospital Owned Provider-Based Clinic Facility Fee Reporting (PDF)

Instructions for completing DOH Form 346-094 (PDF)