October 4, 2015 4:09 AM
The max fee schedules
For most services, Wisconsin BadgerCare Plus reimburses providers the lesser of the billed amount or the maximum allowable fee established by the Department of Health Services (DHS) based on legislative directives. The amounts established by the DHS are published in fee schedules, available to all providers and other interested parties.
This information is intended to help you understand the Wisconsin BadgerCare Plus Maximum Allowable Fee Schedule. If you have questions, please contact
at (800) 947-9627. When requesting information, please be specific as to which provider type you are referring (e.g., Ambulance).
When using the fee schedules, remember the following:
HMOs negotiate rates with their individual providers, and these rates may differ from Wisconsin BadgerCare Plus fee-for-service rates. Contact the HMO or check your contract with the HMO for their reimbursement rates.
Wisconsin BadgerCare Plus requires most providers to bill their usual and customary charge for services provided to BadgerCare Plus members. Therefore, providers should not use the fee schedules to set their rates. "Usual and customary charge" means the provider's charge for providing the same service to persons not eligible for BadgerCare Plus benefits.
Reimbursement rates may change during the year. Wisconsin BadgerCare Plus notifies providers of significant rate changes.
Different areas of a provider's office, such as billing and medical services, may have different uses for these fee schedules. Please share these schedules with appropriate staff.
All policy information is not listed in the max fee schedules. Please refer to the appropriate provider handbook for applicable policy for each procedure code.
Begin using the interactive
max fee schedule
max fee schedules
(applies to BadgerCare Plus providers only).
Drug Search Tool.
Interactive Max Fee Search
Download Fee Schedules
ACA Primary Care Rate Increase CY2014 Fee Schedule
ACA Primary Care Rate Increase CY2013 Fee Schedule
Search Online Handbooks
Nursing Home Rate Schedule
View the Max Fee User Guide
Wisconsin Department of Health Services