Maximum Allowable Fee Schedule

The Downloadable Max Fee Schedules and legacy file extracts on the Managed Care Reports page will be removed on February 1, 2027.

For most services, ForwardHealth reimburses providers the lower amount between what they bill and the maximum fee set by the Wisconsin Department of Health Services (DHS) based on legislative directives. The amounts established by DHS are published in fee schedules. Providers can find the fee schedule they need in the interactive maximum allowable fee schedule.

When using the fee schedule, remember:

• HMOs and managed care organizations (MCOs) negotiate rates with their individual providers, and these rates may differ from ForwardHealth fee-for-service rates. Providers seeking information about the reimbursement rates of an HMO or MCO should check their contract or reach out to their HMO or MCO.
• Providers should not use fee schedules to set their rates. ForwardHealth requires most providers to bill their usual and customary charge for services provided to members.
• Reimbursement rates may change during the year. ForwardHealth notifies providers of significant rate changes.
• The fee schedules are not proprietary information.

For full policy and billing information, refer to the ForwardHealth Online Handbook.

For more information or if providers have questions about specific fee schedules, contact Provider Services at 800-947-9627. When requesting information, providers should identify their specific provider type.

Interactive Fee Schedule Resources

Resources are available to help providers navigate the interactive maximum allowable fee schedule and convert search results to exportable files.

Find more information on how to navigate the interactive fee schedule and convert search results to exportable files in these resources:

• How to Search the Interactive Maximum Allowable Fee Schedule training (14:48)
• Understanding Search Results Using the Interactive Maximum Allowable Fee Schedule training (9:37)
• ForwardHealth Portal Maximum Allowable Fee Schedule User Guide, P00957 (PDF) (This user guide will be updated to reflect removal of the downloadable max fee schedule on February 1, 2027.)

HMO and MCO Portal users can find more information on how to navigate the enhanced max fee schedule in the ForwardHealth Managed Care Organization Pricing Administration Guide (PDF), which will be updated to reflect removal of the downloadable max fee schedule on February 1, 2027.

For additional guidance, refer to these trainings on the Trainings page.