Covered and Noncovered Services : Obstetric Care

Newborn Screenings

All providers are required to offer to test newborns for certain congenital and metabolic disorders, per Wis. Stat. § 253.13. These tests require a prepaid filter paper card purchased from the State Laboratory of Hygiene. Wisconsin Medicaid reimburses providers for purchasing the prepaid filter paper cards for newborn screenings performed outside a hospital setting. Medicaid reimbursement for the filter paper cards includes the laboratory handling fee. Reimbursement is limited to one prepaid filter paper card per newborn. When a baby is delivered in the home or birthing center, providers are required to use HCPCS code S3620 (Newborn metabolic screening panel, includes test kit, postage and the laboratory tests specified by the state for inclusion in this panel [e.g. galactose; hemoglobin, electrophoresis; hydroxyprogesterone, 17-D; PKU; and thyroxine, total]) to report the screening panel service.

Newborn Hearing Screening

Evoked otoacoustic emissions hearing screens for newborns are included in the E&M of the newborn and are not separately reimbursable. Wisconsin Medicaid separately reimburses CPT code 92650 (Auditory evoked potentials; screening of auditory potential with broadband stimuli; automated analysis) following a newborn's failed hearing screening, if medically necessary.

Critical Congenital Heart Disease Screening

Screening for critical congenital heart disease by pulse oximetry is included in the initial E&M of the newborn and is not separately reimbursable.