Medicine and Surgery Section - Wisconsin.gov

Reimbursement
• Confirming or revising diagnoses.
• Determining the course of treatment to be
followed.
• Making frequent review of the recipient’s
progress.
The notes must indicate that the supervising
physician personally reviewed the recipient’s
medical history, performed a physical and/or
psychiatric examination, confirmed or revised
the diagnosis, and discharged the recipient.
Residents
Wisconsin Medicaid reimburses residents for
physician services when:
• The resident is fully licensed to practice
medicine and has obtained a Medicaid
provider number.
• The service can be separately identified
from those services that are required as
part of the training program.
• The resident is operating independently
and not under the direct supervision of a
physician.
• The service is provided in a clinic, an
outpatient hospital, or emergency
department setting.
The reimbursement for residents is identical to
other licensed physicians.
Physician Assistants
Wisconsin Medicaid generally reimburses
physician assistants 90 percent of the payment
allowed for the physician who would have
otherwise performed the service. Physician
assistants are paid 100 percent of the
physician’s maximum fee for HealthCheck
screens, injections, immunizations, lab handling
fees, and select diagnostic procedures.
Nurse Practitioners
Nurse practitioners receive the same
reimbursement as physicians for services.
Ancillary Providers
Wisconsin Medicaid covers counseling
services (e.g., weight management, diabetic,
smoking cessation, and prenatal services),
coordination of care services, and delegated
medical acts (e.g., giving injections or
immunizations, checking medications, changing
dressings) provided by ancillary providers if all
of the following are true:
• The services are provided under the
direct, immediate, on-site supervision of a
physician.
• The services are pursuant to the
physician’s plan of care.
• The supervising physician has not also
provided Medicaid reimbursable services
during the same office or outpatient
evaluation and management (E&M) visit.
Examples of ancillary providers include non-
Medicaid certifiable health care professionals
such as staff nurses, dietician counselors,
nutritionists, health educators, genetic
counselors, and some nurse practitioners.
(Nurse practitioners, nurse midwives, and
anesthetists who are Medicaid certified should
refer to their service-specific Medicaid
publications for billing information.)
“On-site” means that the supervising physician
is in the same building in which services are
being provided and is immediately available for
consultation or, in the case of emergencies, for
direct intervention. The physician is not
required to be in the same room as the
ancillary provider, unless dictated by medical
necessity and good medical practice.
Since ancillary providers are not Medicaideligible
providers, claims for these services
must be submitted under the supervising
physician’s Medicaid provider number using
the lowest appropriate level office or outpatient
visit procedure code or other appropriate
Current Procedural Terminology (CPT)
code for the service performed. These
services are not to be billed in addition to or
combined with the physician service if the
physician sees the patient during the same visit.
60 Wisconsin Medicaid and BadgerCare dhfs.wisconsin.gov/medicaid/ December 2005
Wisconsin
Medicaid generally
reimburses
physician
assistants 90
percent of the
payment allowed
for the physician
who would have
otherwise
performed the
service.