Wisconsin Reimbursement for Telehealth

Wisconsin Medicaid Reimburses for Telehealth and the added facility fee.  This added fee per session is more revenue that you can collect to reimburse for added equipment and staffing.  Becuase our solution This would pay for our services rather quickly and the rest would be added revenue for your organization.

Below is an excerpt from Manual provided by the Wisconsin Department of Health Services:

Reimbursable Telemedicine Services

The following individual providers are reimbursed for selected telemedicine-based services:

  • Physicians and physician clinics.
  • RHCs.
  • FQHCs.
  • Physician assistants.
  • Nurse practitioners.
  • Nurse midwives.
  • Psychiatrists in private practice.
  • Ph.D. psychologists in private practice.

These providers may be reimbursed, as appropriate, for the following services provided through telemedicine:

  • Office or other outpatient services (CPT procedure codes 99201-99205, 99211-99215).
  • Office or other outpatient consultations (CPT codes 99241-99245).
  • Initial inpatient consultations (CPT codes 99251-99255).
  • Outpatient mental health services (CPT codes 90801-90849, 90862, 90875, 90876, and 90887).
  • Health and behavior assessment/intervention (CPT codes 96150-96152, 96154-96155).
  • ESRD-related services (CPT codes 90951-90952, 90954-90958, 90960-90961).
  • Outpatient substance abuse services (HCPCS codes H0022, H0047, T1006).

Reimbursement for these services is subject to the same restrictions as face-to-face contacts (e.g., POS, allowable providers, multiple service limitations, PA).

Claims for services performed via telemedicine must include HCPCS modifier "GT" (via interactive audio and video telecommunication systems) with the appropriate procedure code and must be submitted on the 837P transaction or 1500 Health Insurance Claim Form paper claim form. Reimbursement is the same for these services whether they are performed face-to-face or through telemedicine.

Only one eligible provider may be reimbursed per member per DOS for a service provided through telemedicine unless it is medically necessary for the participation of more than one provider. Justification for the participation of the additional provider must be included in the member's medical record.

Separate services provided by separate specialists for the same member at different times on the same DOS may be reimbursed separately.

There is no law mandating payment parity for private insurance companies but many are seeing the benefits and choosing to do so.  Contact the payer directly for more information about what they may cover.

We would love to help you get started offering telehealth services or grow your telehealth program in Wisconsin.  We offer a HIPAA- Compliant Live Video Conferencing solution that meets all of the requirements in the state.  At Secure Telehealth, we have over 10 years of experience helping organizations implement successful telehealth programs.  We fully manage your telehealth program so you don't have to.  Your patients work directly with us to get set up for their first appointment. When they have questions or technical problems, they call us so that none of your time is wasted and appointments are not missed.  We would love to work with you as well.  Contact us below with any questions that you may have about Telehealth and Telemedicine in Wisconsin.

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