Medicine and Surgery Section - Wisconsin.gov

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Appendix HPSA Name County ZIP Codes Minong/Solon Springs Mondovi Mountain/White Lake Oconto/Oconto Falls Platteville/Cuba City Portage/Pardeeville Price/Mellen Pulaski Appendix 25 (Continued) Douglas 54820, 54830, 54838, 54849, 54859, 54873 Washburn 54859, 54875, 54888 Buffalo 54610, 54622, 54736, 54747, 54755 Pepin 54755 Langlade 54430, 54465, 54491 Oconto 54112, 54114, 54138, 54149, 54161, 54174, 54175, 54491 Oconto 54101, 54124, 54139, 54141, 54153, 54154, 54171, 54174 Shawano 54127 Grant 53554, 53807, 53811, 53818, 53820 Iowa 53554, 53580 Lafayette 53510, 53803, 53807, 53811, 53818 Columbia 53901, 53911, 53923, 53928, 53932, 53935, 53954, 53955, 53956, 53960, 53969 Dodge 53956, 53957 Ashland 54514, 54527, 54546 Iron 54552 Price Entire county: 54459, 54513, 54514, 54515, 54524, 54530, 54537, 54552, 54555, 54556, 54564 Brown 54162 Shawano 54162, 54165 Oconto 54162 Rusk County Rusk Entire county: 54526, 54530, 54563, 54728, 54731, 54745, 54757, 54766, 54817, 54819, 54835, 54848, 54868, 54895 Sister Bay/Washington Island Door 54202, 54210, 54211, 54212, 54234, 54246 Sparta Monroe 54615, 54619, 54648, 54656 Spooner/Shell Lake Washburn 54801, 54813, 54817, 54870, 54871, 54875, 54888 Spring Green/Plain Stanley/Cornell Richland 53556 Sauk 53556, 53577, 53578, 53583, 53588, 53937, 53943, 53951 Chippewa 54726, 54727, 54732, 54745, 54757, 54766, 54768 Eau Claire 54722, 54726, 54742, 54768 Sturgeon Bay Door 54201, 54202, 54204, 54209, 54213, 54217, 54235 152 Wisconsin Medicaid and BadgerCare dhfs.wisconsin.gov/medicaid/ December 2005
HPSA Name County ZIP Codes Appendix 25 (Continued) Taylor County Taylor Entire county: 54422, 54425, 54433, 54434, 54439, 54447, 54451, 54460, 54470, 54480, 54490, 54498, 54766, 54768, 54771 Tigerton/Birnamwood Tomahawk Marathon 54408, 54414, 54427, 54429, 54440, 54499 Shawano 54409, 54414, 54416, 54427, 54450, 54486, 54499 Waupaca 54486, 54926, 54945 Lincoln 54435, 54442, 54487, 54501, 54564 Oneida 54487, 54529, 54564 Wausau, City of Marathon 54401, 54403 Waushara Waushara 54909, 54923, 54930, 54940, 54943, 54960, 54965, 54966, 54967, 54970, 54981, 54982, 54984 Western Marinette Marinette 54102, 54104, 54112, 54114, 54119, 54125, 54151, 54156, 54159, 54161, 54177 Physician Services Handbook — Medicine and Surgery December 2005 153 Appendix
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Physician Services Medicine and Sur
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T Table of Contents Preface .......
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Telemedicine ......................
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Health Professional Shortage Areas
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Legal Framework The following laws
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General Information Treatment (EPSD
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General Information Category III Co
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General Information collecting the
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General Information • The current
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Evaluation and Management reimburse
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Evaluation and Management in an out
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Evaluation and Management 22 Wiscon
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Medicine Services System [HCPCS] co
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Medicine Services In cases where mo
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Medicine Services documentation in
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Medicine Services Providers of ment
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Medicine Services Substance Abuse S
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Surgery Services Appendix 10 of thi
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Surgery Services Cataract Surgery W
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Surgery Services and the insertion
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Surgery Services Note: A telephone
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Surgery Services • Sterilization.
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Surgery Services live with her sinc
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Surgery Services by a multi-discipl
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Prescription Requirements Prescribe
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Prescription Requirements Approval
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Prescription Requirements prescribe
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Prescription Requirements 54 Wiscon
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Claims Submission adjustment reques
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Claims Submission 58 Wisconsin Medi
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Reimbursement • Confirming or rev
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Reimbursement about whether a speci
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Reimbursement 64 Wisconsin Medicaid
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Appendix 66 Wisconsin Medicaid and
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Appendix Surgery Services Appendix
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Appendix Medicine Services (Continu
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Appendix Other Services Appendix 1
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Appendix Appendix 4 (Continued) If
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Appendix Appendix 4 (Continued) Ele
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Appendix Appendix 4 (Continued) Ele
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Appendix (This page was intentional
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ABORTION CERTIFICATION STATEMENTS P
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Appendix (This page was intentional
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STERILIZATION INFORMED CONSENT FORM
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Page 114 and 115: Appendix Appendix 15 (Continued) Pe
Page 116 and 117: Appendix Category Musculoskeletal S
Page 118 and 119: Appendix Category Musculoskeletal S
Page 120 and 121: Appendix Category Female Genital Sy
Page 122 and 123: Appendix SECTION II — RECIPIENT I
Page 124 and 125: Appendix 122 Wisconsin Medicaid and
Page 132 and 133: Appendix PRIOR AUTHORIZATION / PHYS
Page 136 and 137: PRIOR AUTHORIZATION / PHYSICIAN ATT
Page 140 and 141: PRIOR AUTHORIZATION / “J” CODE
Page 144 and 145: PRIOR AUTHORIZATION / “J” CODE
Page 148 and 149: PRIOR AUTHORIZATION / PHYSICIAN OTO
Page 152 and 153: Appendix Health Professional Shorta
Page 158 and 159: Appendix Appendix 26 (Continued) ma
Page 160 and 161: Appendix The following table lists
Page 172 and 173: DECLARATION OF SUPERVISION FOR NONB
Page 176 and 177: Appendix HCPCS Code* Drug Name Diag
Page 178: Index Organ Transplants, 44 Provide
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