Medicine and Surgery Section - Wisconsin.gov

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Reimbursement 64 Wisconsin Medicaid and BadgerCare dhfs.wisconsin.gov/medicaid/ December 2005
Appendix Physician Services Handbook — Medicine and Surgery December 2005 65 Appendix
Page 1 and 2:
Physician Services Medicine and Sur
Page 3 and 4:
T Table of Contents Preface .......
Page 5 and 6:
Telemedicine ......................
Page 7:
Health Professional Shortage Areas
Page 10 and 11:
Legal Framework The following laws
Page 12 and 13:
General Information Treatment (EPSD
Page 14 and 15:
General Information Category III Co
Page 16 and 17: General Information collecting the
Page 18 and 19: General Information • The current
Page 20 and 21: Evaluation and Management reimburse
Page 22 and 23: Evaluation and Management in an out
Page 24 and 25: Evaluation and Management 22 Wiscon
Page 26 and 27: Medicine Services System [HCPCS] co
Page 28 and 29: Medicine Services In cases where mo
Page 30 and 31: Medicine Services documentation in
Page 32 and 33: Medicine Services Providers of ment
Page 34 and 35: Medicine Services Substance Abuse S
Page 36 and 37: Surgery Services Appendix 10 of thi
Page 38 and 39: Surgery Services Cataract Surgery W
Page 40 and 41: Surgery Services and the insertion
Page 42 and 43: Surgery Services Note: A telephone
Page 44 and 45: Surgery Services • Sterilization.
Page 46 and 47: Surgery Services live with her sinc
Page 48 and 49: Surgery Services by a multi-discipl
Page 50 and 51: Prescription Requirements Prescribe
Page 52 and 53: Prescription Requirements Approval
Page 54 and 55: Prescription Requirements prescribe
Page 56 and 57: Prescription Requirements 54 Wiscon
Page 58 and 59: Claims Submission adjustment reques
Page 60 and 61: Claims Submission 58 Wisconsin Medi
Page 62 and 63: Reimbursement • Confirming or rev
Page 64 and 65: Reimbursement about whether a speci
Page 68 and 69: Appendix 66 Wisconsin Medicaid and
Page 70 and 71: Appendix Surgery Services Appendix
Page 72 and 73: Appendix Medicine Services (Continu
Page 74 and 75: Appendix Other Services Appendix 1
Page 80 and 81: Appendix Appendix 4 (Continued) If
Page 82 and 83: Appendix Appendix 4 (Continued) Ele
Page 84 and 85: Appendix Appendix 4 (Continued) Ele
Page 96 and 97: Appendix (This page was intentional
Page 98 and 99: ABORTION CERTIFICATION STATEMENTS P
Page 102 and 103: STERILIZATION INFORMED CONSENT FORM
Page 104 and 105: DEPARTMENT OF HEALTH AND FAMILY SER
Page 114 and 115: Appendix Appendix 15 (Continued) Pe
Page 116 and 117:
Appendix Category Musculoskeletal S
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Appendix Category Musculoskeletal S
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Appendix Category Female Genital Sy
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Appendix SECTION II — RECIPIENT I
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Appendix 122 Wisconsin Medicaid and
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Appendix (This page was intentional
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Appendix PRIOR AUTHORIZATION / PHYS
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PRIOR AUTHORIZATION / PHYSICIAN ATT
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PRIOR AUTHORIZATION / “J” CODE
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PRIOR AUTHORIZATION / “J” CODE
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Page 148 and 149:
PRIOR AUTHORIZATION / PHYSICIAN OTO
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DEPARTMENT OF HEALTH AND FAMILY SER
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Appendix Health Professional Shorta
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Appendix HPSA Name County ZIP Codes
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Appendix Appendix 26 (Continued) ma
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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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