Medicine and Surgery Section - Wisconsin.gov

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Medicine Services Substance Abuse Services Wisconsin Medicaid covers the following substance abuse services: • Individual substance abuse therapy. • Family substance abuse therapy. • Group substance abuse therapy. Physicians interested in providing substance abuse should refer to service-specific Medicaid publications, which may be downloaded from the Medicaid Web site or obtained by calling Provider Services at (800) 947-9627 or (608) 221-9883. Telemedicine Telemedicine is the use of telecommunications technology for diagnostic, monitoring, and medical education purposes. Wisconsin Medicaid does not cover telemedicine services. Weight Management Services Weight management services (e.g., diet clinics, obesity programs, weight loss programs) are reimbursable only if performed by or under the direct, on-site supervision of a physician and if performed in a physician’s office. Weight management services exceeding five visits per calendar year require PA. Prescription drugs prescribed for weight loss also require PA. (Refer to the Pharmacy Handbook for additional information about prescription drug PA requirements.) Submit claims for weight management services with the appropriate E&M procedure code. For weight management services, food supplements and dietary supplies (e.g., liquid or powdered diet foods or supplements, OTC diet pills, and vitamins) that are dispensed during an office visit are not separately reimbursable by Wisconsin Medicaid. 32 Wisconsin Medicaid and BadgerCare dhfs.wisconsin.gov/medicaid/ December 2005 Wisconsin Medicaid does not cover telemedicine services.
When an abortion meets the state and federal requirements for Medicaid payment, Wisconsin Medicaid covers office visits and all other medically necessary related services. Surgery Services Abortions Coverage Policy In accordance with s. 20.927, Wis. Stats., Wisconsin Medicaid covers abortions when one of the following situations exists: • The abortion is directly and medically necessary to save the life of the woman, provided that prior to the abortion the physician attests, based on his or her best clinical judgment, that the abortion meets this condition by signing a certification. • In a case of sexual assault or incest, provided that prior to the abortion the physician attests to his or her belief that sexual assault or incest has occurred, by signing a written certification and provided that the crime has been reported to the law enforcement authorities. • Due to a medical condition existing prior to the abortion, the physician determines that the abortion is directly and medically necessary to prevent grave, long-lasting physical health damage to the woman, provided that prior to the abortion, the physician attests, based on his or her best clinical judgment, that the abortion meets this condition by signing a certification. The optional Abortion Certification Statements form, HCF 1161, is located in Appendix 10 of this section for photocopying and may also be downloaded and printed from the Medicaid Web site. Providers may develop a form of their own, as long as it includes the same information. Covered Services When an abortion meets the state and federal requirements for Medicaid payment, Wisconsin Medicaid covers office visits and all other medically necessary related services. Wisconsin Medicaid covers treatment for complications arising from an abortion, regardless whether the abortion itself is a covered service, because the complications represent new conditions, and thus the services are not directly related to the performance of an abortion. Coverage of Mifeprex Wisconsin Medicaid reimburses for Mifeprex under the same coverage policy that it reimburses other surgical or medical abortion procedures under s. 20.927, Wis. Stats. When submitting claims for Mifeprex, providers are required to: • Use the Healthcare Common Procedure Coding System (HCPCS) code S0190 (Mifepristone, oral, 200 mg) for the first dose of Mifeprex, along with the evaluation and management (E&M) code that reflects the service provided. Do not use HCPCS code S0199; bill components (i.e., ultrasounds, office visits) of services performed separately. • Use the HCPCS code S0191 (Misoprostol, oral, 200 mcg), for the drug given during the second visit, along with the E&M code that reflects the service provided. Do not use HCPCS code S0199; bill components (i.e., ultrasounds, office visits) of services performed separately. • For the third visit, use the E&M code that reflects the service provided. • Include the appropriate International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) abortion diagnosis code with each claim submission. • Attach to each claim a completed abortion certification statement that includes information showing the situation is one in which Wisconsin Medicaid covers the abortion. The optional Abortion Certification Statements form is located in Physician Services Handbook — Medicine and Surgery December 2005 33 Surgery Services
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Page 10 and 11: Legal Framework The following laws
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ABORTION CERTIFICATION STATEMENTS P
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STERILIZATION INFORMED CONSENT FORM
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DEPARTMENT OF HEALTH AND FAMILY SER
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Appendix Category Musculoskeletal S
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Appendix SECTION II — RECIPIENT I
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Appendix PRIOR AUTHORIZATION / PHYS
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PRIOR AUTHORIZATION / “J” CODE
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Appendix Health Professional Shorta
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Appendix HPSA Name County ZIP Codes
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Appendix The following table lists
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DECLARATION OF SUPERVISION FOR NONB
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Appendix HCPCS Code* Drug Name Diag
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Index Organ Transplants, 44 Provide
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Medicine and Surgery Section - Wisconsin.gov

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