Reimbursement : Amounts

Private Room

When isolation precautions are medically necessary and a private room is prior authorized, a provider may receive additional reimbursement equal to the facility's Wisconsin Medicaid rate plus the difference between the facility's daily private-pay semi-private room rate and private-pay room rate, up to $35.00. Documentation of this rate differential must accompany the prior authorization request.

The member or legal representative may not, in this case, be held responsible for any of the additional cost of a private room since it is a covered service.

Note: In instances where the facility does not have any semi-private rooms, additional reimbursement will not be paid.