Forward Health WI - online handbook for providers
Hi Lisa,
Forward Health Wisconsin has online handbooks published, and under Badger care Plus and Medicaid has the following guidelines:
Immunizations:
Topic 503:
Providers are required to indicate the code of the actual vaccine administered, not the administration code, on claims for all immunizations. Reimbursement for both the vaccines when appropriate, and the administration are included in the reimbursement of the vaccine code, so providers should not bill the administration code. Providers are required to indicate their usual customary charge for the service with procedure code.
Medicaid reimbursement for immune globulins, vaccines, toxoid immunization and the unlisted vaccine/toxoid procedure codes include the reimbursement for the administration component of the immunization contrary to the CPTs definition of the procedure code. Procedure codes for administration are not separately reimbursable.
Note: This section continues with separate guidelines with Vaccines for children 18 years and younger followed by members 19 years and older.
Venipuncture:
Topic #51
Services Not Separately Reimbursable
If reimbursement for a service is included in the reimbursement for the primary procedure or service, it is not separately reimbursable. For example, routine venipuncture is not separately reimbursable, but it is included in the reimbursement for the laboratory procedure or the laboratory test preparation and handling fee. Also, DME delivery charges are included in the reimbursement for DME items.
Thanks,
Rudolph