Covered and Noncovered Services : Noncovered Services

Definition of Noncovered Services

A noncovered service is a service, item, or supply for which reimbursement is not available. Wis. Admin. Code § DHS 101.03(103) and Wis. Admin. Code ch. 107 contain more information about noncovered services. In addition, Wis. Admin. Code § DHS 107.03 contains a general list of noncovered services.

Noncovered Durable Medical Equipment and Services

Providers must use the PA process to determine the medical necessity of any medical equipment requests based on the member's individual circumstances and needs.

Note: For members under 21 years of age, HealthCheck Other Services may allow coverage of certain services regardless of whether the service is covered in the state's Medicaid program.

ForwardHealth does not cover the following:

• Equipment and services that are excluded from coverage under Wis. Admin. Code § DHS 107.03
• Noncovered equipment according to federal law:
  • Medical equipment and appliances not primarily medical in nature and not useful to an individual in the absence of a disability, per 42 C.F.R. § 440.70(b)(3)(ii)
  • Environmental or structural housing modifications and vehicle modifications, per Federal Register, volume 81(21), Feb 2, 2016, p 5538, 5539, 5542

• Certain foot orthoses or orthopedic or corrective shoes
• DME that are not primarily medical in nature, including items in the following categories:
  • Emergency alert contact systems or services
  • Exercise and fitness equipment
  • Non-rehab technology
  • Restraints and safety equipment