For Dates of Service Before January 1, 2022

Preventive Medicine Services

Wisconsin Medicaid reimburses family planning clinic providers for preventive medicine services provided to eligible members.

Covered services include initial preventive medicine E&M of new patients (Physician's CPT 99384-99387) and reevaluation and management of established patients (CPT 99394-99397), including:

Prescriptions

Prescribing Contraceptive Methods

The prescribing of contraceptive methods is a covered service with reimbursement included in the reimbursement for the office visit. The contraceptive method selected should be the choice of the member, based on full information, except when in conflict with sound medical practice.

The following covered services may be prescribed:

Prescribing Breast Pumps

Wisconsin Medicaid reimburses for the prescribing of breast pumps as part of an E&M office visit. The following three types of breast pumps are covered:

Family planning clinic providers may prescribe breast pumps to members who meet all of the following criteria:

The optional Breast Pump Order form may be completed by the prescribing family planning clinic provider.

Family planning clinic physicians or nurse practitioners may prescribe breast pumps for members, which can then be obtained through a Medicaid-enrolled DME provider or pharmacy. Wisconsin Medicaid does not reimburse family planning clinics for supplying breast pumps, unless they are also Medicaid-enrolled as a DME provider or pharmacy.

Counseling Services

Counseling services in the clinic are covered and may be performed or supervised by a physician, registered nurse, or nurse practitioner, according to Wis. Admin. Code § DHS 107.21(1)(d). Counseling services may be provided as a result of a member's request or by indications from exam procedures and history. Wisconsin Medicaid denies reimbursement for counseling services not identified as part of an E&M service (Physicians' CPT counseling codes [99401-99404] are not recognized by Wisconsin Medicaid).

According to Wis. Admin. Code § DHS 107.21(1)(d), covered counseling services are limited to the following areas: