PAC - THE PRICING ACTION CODE IDENTIFIES NON-COVERED SERVICES OR THE SOURCE AND METHOD OF PRICING THE PROCEDURE (REFER TO TABLE II).
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1 PHYSICAL THERAPY, OCCUPATIONAL THERAPY, AND SPEECH AND LANGUAGE PATHOLOGY MAXIMUM ALLOWABLE FEE SCHEDULE THIS IS YOUR WISCONSIN MEDICAID MAXIMUM ALLOWABLE FEE SCHEDULE, WHICH IS IN EFFECT AS OF THE DATE OF THIS REPORT. WISCONSIN MEDICAID CERTIFIED PROVIDERS WILL BE REIMBURSED FOR SERVICES PROVIDED TO PROGRAM RECIPIENTS AT THE LOWER OF THEIR USUAL AND CUSTOMARY CHARGE, OR THE MAXIMUM ALLOWABLE FEE. SERVICES REIMBURSED BASED ON PROVIDER SPECIFIC (CONTRACTED RATES) AND REGIONAL OR SPECIALTY BASED RATES ARE NOT INCLUDED IN THIS FEE SCHEDULE. NOTE: BADGERCARE PLUS BENCHMARK PLAN MEMBERS WILL BE RESPONSIBLE FOR A $15.00 COPAYMENT PER THERAPY VISIT, REGARDLESS OF THE NUMBER OF SERVICES PROVIDED DURING THAT VISIT. ALTHOUGH THE FEE SCHEDULE DOES NOT ADDRESS THE VARIOUS COVERAGE LIMITATIONS ROUTINELY APPLIED BY WISCONSIN MEDICAID BEFORE FINAL PAYMENT IS DETERMINED (E.G., RECIPIENT AND PROVIDER ELIGIBILITY, BILLING INSTRUCTIONS, FREQUENCY OF SERVICES, THIRD PARTY LIABILITY, COPAYMENT, AGE RESTRICTIONS, PRIOR AUTHORIZATION, ETC.), IT DOES CONTAIN THE FOLLOWING INFORMATION: PROC/M1/M2/TM PROC - THE PROCEDURE CODE RECOGNIZED BY WISCONSIN MEDICAID TO IDENTIFY THE SERVICE PROVIDED. M1/M2 - ONE OR TWO APPLICABLE MODIFIER(S) AFFECTING REIMBURSEMENT AMOUNT. TM - DESCRIPTIVE MODIFIER USED TO CONVEY INFORMATION FORMERLY CONVEYED BY TOS. NOTE: IN CERTAIN INSTANCES THE MODIFIER LISTED IS BEING USED BOTH TO CONVEY INFORMATION FORMERLY CONVEYED BY TOS AND TO AFFECT THE REIMBURSEMENT AMOUNT. IN THESE INSTANCES THE MODIFIER WILL BE DISPLAYED TWICE, ONCE IN THE M1 OR M2 COLUMN AND ONCE IN THE TM COLUMN, EVEN THOUGH IT WILL ONLY BE BILLED ONCE ON THE CLAIM DETAIL. DESCRIPTION - AN ABBREVIATED DESCRIPTION OF THE PROCEDURE CODE PROVIDER TYPE - ALL APPLICABLE PERFORMING PROVIDER TYPES FOR THE PROCEDURE CODE. SEE TABLE I FOR A LISTING OF PROVIDER TYPES APPLICABLE TO THIS SCHEDULE. PAC - THE PRICING ACTION CODE IDENTIFIES NON-COVERED SERVICES OR THE SOURCE AND METHOD OF PRICING THE PROCEDURE (REFER TO TABLE II). EFFECT DATE - THE EFFECTIVE DATE OF SERVICE ON OR AFTER WHICH THE MAXIMUM ALLOWABLE FEE APPLIES. MAX FEE - MAXIMUM ALLOWABLE FEES FOR THE PROCEDURE CODES LISTED. IF A MAX FEE IS NOT INDICATED, USE THE PAC AND TABLE II TO DETERMINE THE REASON (E.G., PAC 220 INDICATES SERVICE NOT COVERED; PAC 21J INDICATES INDIVIDUAL CONSIDERATION, ETC.). THIS INFORMATION IS INTENDED TO HELP YOU UNDERSTAND THE WISCONSIN MEDICAID MAXIMUM ALLOWABLE FEE SCHEDULE. IF YOU HAVE QUESTIONS, PLEASE CONTACT WISCONSIN MEDICAID PROVIDER SERVICES AT: (608) OR (800) * *WHEN REQUESTING INFORMATION, PLEASE BE SPECIFIC AS TO WHICH PROVIDER TYPE YOU ARE REFERRING (I.E. PHYSICAL THERAPIST, OCCUPATIONAL THERAPIST, THERAPY GROUP, REHABILITATION AGENCY, OR
2 SPEECH PATHOLOGY/ THERAPY. TABLE I PROVIDER TYPES 34 - PHYSICAL THERAPIST 35 - OCCUPATIONAL THERAPIST 38 - THERAPY GROUP 65 - REHABILITATION AGENCY 78 - SPEECH PATHOLOGY/THERAPY TABLE II PRICING ACTION CODES (PAC) 11J, 21J - INDIVIDUAL CONSIDERATION, MEDICAL CONSULTANT 120, NON-COVERED SERVICE, NOT A WISCONSIN MEDICAID BENEFIT 170, PAID AT THE LOWER OF THE BILLED AMOUNT OR MAXIMUM ALLOWABLE FEE ACCORDING TO PROVIDER TYPE TABLE III MODIFIERS MODIFIER DESCRIPTION TF INTERMEDIATE LEVEL OF CARE PROC DESCRIPTION PROC M1 M2 TM PROVIDER TYPE PAC EFFECT MAX FEE DATE LARYNGOSCOPY, FLEXIBLE FIBEROPTIC, DIAGNOSTIC /01/ LARYNGOSCOPY, FLEXIBLE FIBEROPTIC; DIAGNOSTIC /01/ LARYNGOSCOPY, FLEXIBLE OR RIGID FIBEROPTIC, WITH STROBOSCOPY /01/ LARYNGOSCOPY, FLEXIBLE OR RIGID FIBEROPTIC, WITH STROBOSCOPY /01/ BIOFEEDBACK TRAINING BY ANY MODALITY (15 MINUTES) /01/ TF /01/ EVALUATION OF SPEECH, LANGUAGE, VOICE, COMMUNICATION, AND/OR AUDITORY PROCESSING /01/ EVALUATION OF SPEECH, LANGUAGE, VOICE, COMMUNICATION, AND/OR AUDITORY PROCESSING /01/ TREATMT OF SPEECH, LANGUAGE, VOICE, COMMUN, &/OR AUDITORY PROCSSING DISORDER; INDIVIDUAL /01/ TREATMT OF SPEECH, LANGUAGE, VOICE, COMMUN, &/OR AUDITORY PROCSSING DISORDER; INDIVIDUAL /01/ TREAT OF SPEECH, LANG, VOICE, COMMUN, A/O AUDITORY PRCSSING DISORDER; 2 OR MORE INDIVIDU /01/ TREAT OF SPEECH, LANG, VOICE, COMMUN, A/O AUDITORY PRCSSING DISORDER; 2 OR MORE INDIVIDU /01/ NASOPHARYNGOSCOPY WITH ENDOSCOPE (SEPARATE PROCEDURE) /01/ NASOPHARYNGOSCOPY WITH ENDOSCOPY (SEPARATE PROCEDURE) /01/ NASAL FUNCTION STUDIES (EG, RHINOMANOMETRY) /01/
3 92512 NASAL FUNCTION STUDIES (EG, RHINOMANOMETRY) /01/ LARYNGEAL FUNCTION STUDIES (IE, AERODYNAMIC TESTING AND ACOUSTIC TESTING) /01/ LARYNGEAL FUNCTION STUDIES (IE, AERODYNAMIC TESTING AND ACOUSTIC TESTING) /01/ TREATMENT OF SWALLOWING DYSFUNCTION AND/OR ORAL FUNCTION FOR FEEDING /01/ TREATMENT OF SWALLOWING DYSFUNCTION AND/OR ORAL FUNCTION FOR FEEDING /01/ EVAL FOR USE &/OR FITTING OF VOICE PROSTHETIC OR AUGMENTATIVE/ALTERNATIVE COMMUNICATION /01/ EVALUATION OF PATIENT FOR PRESCRIPTION OF VOICE PROSTHETIC /01/ EVAL FOR PRESCRIP FOR SPEECH-GENERATING AUGMENTATVE & ALT COMMUN DEVICE,FACE TO FACE /01/ EVAL FOR PRESCRIP FOR SPEECH-GENERATING AUGMENTATVE & ALT COMMUN DEVICE,FACE TO FACE /01/ EVAL FOR PRESCRIP FOR SPEECH-GENERATG AUGMNTVE & ALT COMM DEVCE,FACE TO FACE /01/ EVAL FOR PRESCRIP FOR SPEECH-GENERTG AUGMENTVE & ALT COMM DEVCE,FACE TO FACE /01/ THERAPEUTIC SVCS FOR THE USE OF SPEECH GENERATING DEVICE,INCL PROGRAMMING & MODIFICATION /01/ THERAPEUTIC SVCS FOR THE USE OF SPEECH-GENERATING DEVICE,INCL PROGRAMMING & MODIFICATION /01/ EVALUATION OF ORAL AND PHARYNGEAL SWALLOWING FUNCTION /01/ EVALUATION OF ORAL AND PHARYNGEAL SWALLOWING FUNCTION /01/ MOTION FLUOROSCOPIC EVALUATION OF SWALLOWING FUNCTION BY CINE OR VIDEO RECORDING /01/ MOTION FLUOROSCOPIC EVALUATION OF SWALLOWING FUNCTION BY CINE OR VIDEO RECORDING /01/ ENDOSCOPIC STUDY OF SWALLOWING FUNCTION (ALSO FIBEROPTIC ENDOSCOPIC EVAL OF SWALLOW (FEE /01/ ENDOSCOPIC STUDY OF SWALLOWING FUNCTION (ALSO FIBEROPTIC ENDOSCOPIC EVAL OF SWALLOW (FEE /01/ SENSORY TESTING DURING ENDOSCOPIC STUDY OF SWALLOWING (ADD ON CODE) REFERRED TO AS FEEST /01/ SENSORY TESTING DURING ENDOSCOPIC STUDY OF SWALLOWING (ADD ON CODE) REFERRED TO AS FEEST /01/ UNLISTED OTORHINOLARYNGOLOGICAL SERVICE OR PROCEDURE J 10/01/ UNLISTED OTORHINOLARYNGOLOGICAL SERVICE OR PROCEDURE J 10/01/ PHYSICIAN SERVICES FOR OUTPATIENT CARDIAC REHABILITATION /01/ PHYSICIAN SERVICES FOR OUTPATIENT CARDIAC REHABILITATION /01/ MANIPULATION CHEST WALL, SUCH AS CUPPING, PERCUSSING, AND /01/ MANIPULATION CHEST WALL, SUCH AS CUPPING, PERCUSSING, /01/ TF /01/ ASSESSMENT OF APHASIA (INCLUDES ASSESSMENT OF EXPRESSIVE AND RECEPTIVE SPEECH AND LANGUA /01/ ASSESSMENT OF APHASIA (INCLUDES ASSESSMENT OF EXPRESSIVE AND RECEPTIVE SPEECH AND LANGUA /01/ PHYSICAL THERAPY EVALUATION /01/ PHYSICAL THERAPY RE-EVALUATION /01/
4 97003 OCCUPATIONAL THERAPY EVALUATION /01/ OCCUPATIONAL THERAPY RE-EVALUATION /01/ TRACTION/ MECHANICAL /01/ TF /01/ VASOPNEUMATIC DEVICES /01/ TF /01/ PARAFFIN BATH /01/ TF /01/ WHIRLPOOL /01/ TF /01/ APPLICATION OF A MODALITY TO ONE OR MORE AREAS; DIATHERMY (EG, MICROWAVE) /01/ TF /01/ INFRARED /01/ TF /01/ ULTRAVIOLET /01/ TF /01/ APPLICATION OF A MODALITY TO ONE OR MORE AREAS;ELECTRICAL STIMULATION (MANUAL),EA 15 MIN /01/ TF /01/ APPLICATION OF A MODALITY TO ONE OR MORE AREAS; IONTOPHORESIS, EACH 15 MINUTES /01/ TF /01/ APPLICATION OF A MODALITY TO ONE OR MORE AREAS; CONTRAST BATHS, EACH 15 MINUTES /01/ TF /01/ APPLICATION OF A MODALITY TO ONE OR MORE AREAS; ULTRASOUND, EACH 15 MINUTES /01/ TF /01/ APPLICATION OF A MODALITY TO ONE OR MORE AREAS; HUBBARD TANK, EACH 15 MINUTES /01/ TF /01/ UNLISTED MODALITY(SPECIFY TYPE AND TIME IF CONSTANT ATTENDANCE) /01/ TF /01/ THERAPEUTIC PROC,ONE OR MORE AREAS,EA 15 MIN,THERAPEUTIC EXERCISES TO DEVELOP STRENGTH /01/ TF /01/ THERAPEUTIC PROCEDURE, ONE OR MORE AREAS; NEUROMUSCULAR REEDUCATION OF MOVEMENT, BALANCE /01/ TF /01/ THERAPEUTIC PROCEDURE, ONE OR MORE AREAS; AQUATIC THERAPY WITH THERAPEUTIC EXERCISES /01/ TF /01/ THERAPEUTIC PROCEDURE, ONE OR MORE AREAS; GAIT TRAINING (INCLUDES STAIR CLIMBING) /01/ TF /01/ THERAPEUTIC PROC, ONE OR MORE AREAS; MASSAGE, INCL EFFLEURAGE, PETRISSAGE &/OR TAPOTEMEN /01/ TF /01/ UNLISTED THERAPEUTIC PROCEDURE (SPECIFY) /01/ TF /01/ MANUAL THERAPY TECHNIQUES, ONE OR MORE REGIONS, EACH 15 MINUTES /01/
5 97140 TF /01/ MANUAL THERAPY TECHNIQUES, ONE OR MORE REGIONS, EACH 15 MINUTES /01/ TF /01/ THERAPEUTIC PROCEDURE(S), GROUP (2 OR MORE INDIVIDUALS) (EACH 15 MINUTES) /01/ TF /01/ THERAPEUTIC ACTIVITIES, DIRECT (ONE ON ONE) PATIENT CONTACT BY THE PROVIDER, EACH 15 MIN /01/ TF /01/ DEVELOPMENT OF COGNITIVE SKILLS TO IMPROVE ATTENTION,MEMORY,PROBLEM SOLV,EACH 15 MIN /01/ TF /01/ DEVELOPMENT OF COGNITIVE SKILLS TO IMPROVE ATTENTION,MEMORY,PROBLEM SOLV,EACH 15 MIN /01/ TF /01/ SENSORY INTEGRATIVE TCHNQS TO ENHANCE SENSORY PROCESS & PROMOTE ADAPTIVE RESPONSES,EA /01/ TF /01/ SENSORY INTEGRATIVE TCHNQU TO ENHANCE SENSORY PROCESS & PROMOTE ADAPTIVE RESPONSES,EA /01/ TF /01/ SELF CARE/HOME MANAGMNT TRAINING(EG,ACTIVITIES OF DAILY LIVING(ADL) & COMPENSATOR,15 MIN /01/ TF /01/ SELF CARE/HOME MANAGMNT TRAINING(EG,ACTIVITIES OF DAILY LIVING(ADL) & COMPENSATOR,15 MIN /01/ TF /01/ WHEELCHAIR MANAGEMENT (EG, ASSESSMENT, FITTING, TRAINING), EACH 15 MINUTES /01/ TF /01/ WHEELCHAIR MANAGEMENT (EG, ASSESSMENT, FITTING, TRAINING), EACH 15 MINUTES /01/ TF /01/ REMVL OF DEVTLZD TISSUE FROM WOUND,SELECT DEBRDMNT,W/O ANESTH,SURFACE AREA< OR =20 SQ CT /01/ REMVL OF DEVTLZD TISSUE FROM WOUND,SELECT DEBRDMNT,W/O ANESTH,SURFACE AREA< OR =20 SQ CT /01/ REMVL OF DEVTLZD TISSUE FROM WOUND,SELECT DBRDMNT,W/O ANESTH,SURFACE AREA> OR =20 SQ CT /01/ REMVL OF DEVTLZD TISSUE FROM WOUND,SELECT DBRDMNT,W/O ANESTH,SURFACE AREA> OR =20 SQ CT /01/ REMOVAL OF DEVITALIZED TISSUE FROM WOUND;NON-SELECTIVE DEBRIDEMENT,W/O ANESTHESIA(EG,WET /01/ ASSISTIVE TECH ASSESSMENT, DIRECT ONE-ON-ONE CONTACT BY PROV W/WRITTEN REPRT/EACH 15 MIN /01/04 G0281 ELECTRICL STIMULATN,(UNATTENDED),TO 1 OR MORE AREAS,FOR CHRONIC STAGE III & IV ULCERS,AS G /01/ G0281 TF /01/ G0282 ELECT. STIMULATION, (UNATTENDED), TO ONE OR MORE AREAS, WOUND CARE OTHER THAN IN G0281 G /01/ G0282 TF /01/ G0283 ELECTRICL STIMULATN,(UNATTENDED),1 OR MORE AREAS FOR INDICATN(S) OTHER THAN WOUND CARE, G /01/ G0283 TF /01/ END OF REPORT
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