Program Name: | BadgerCare Plus and Medicaid | Handbook Area: | HealthCheck (EPSDT) | 03/29/2024 | Covered and Noncovered Services : Covered Services and RequirementsTopic #2396 Interperiodic Visits
Wisconsin Medicaid covers medically necessary interperiodic screens to follow up on detected problems or conditions.
Interperiodic screens are visits with qualified providers that occur outside the AAP periodicity schedule. They may be recommended by any professional who comes into contact with the child, such as physicians, dentists, health officials, or educators.
An interperiodic screen can be problem-focused or may include any or all components of the comprehensive screen. These visits may be required to diagnose a new illness or condition or to determine whether a previously diagnosed illness or condition requires additional services. Interperiodic screens ensure that access to a necessary service is not delayed by waiting until the next scheduled wellness check-up. Examples of interperiodic screens include the following:
- Immunizations
- Retesting for an elevated blood lead level
- Retesting for a low hematocrit
- Addressing nutrition concerns
Like comprehensive HealthCheck screens, conditions identified during an interperiodic screen may result in recommendations for further evaluation or services which may be covered.
Accessing Interperiodic Screens
Interperiodic HealthCheck screens are available without PA, and any Medicaid-enrolled provider, within the scope of their license, may provide these screens. No special forms are required. Topic #3416 Documentation of Guidelines for Evaluation and Management Services
BadgerCare Plus has adopted the federal CMS 2021 and 2023 Documentation Guidelines for Evaluation and Management Services in combination with BadgerCare Plus policy for E&M services. Providers are required to present documentation upon request indicating which of the guidelines or BadgerCare Plus policies were utilized for the E&M procedure code that was billed.
The documentation in the member's medical record for each service must justify the level of the E&M code billed. Providers may access the CMS documentation guidelines on the CMS website. BadgerCare Plus policy information can be found in service-specific areas of the Online Handbook or on the ForwardHealth Portal. |