BadgerCare Plus has adopted the federal CMS 1995 and 1997 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.