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 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. Information regarding HealthCheck "Other Services" can be found in the Definition of HealthCheck "Other Services" and the Prior Authorization for HealthCheck "Other Services" topics of the Online Handbook.

ForwardHealth will continue to 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 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