CATEGORY:

Category type that identifies the DMS supply.

CODE:

Five-digit alphanumeric HCPCS National Level II codes and modifiers developed by the federal CMS, that identify the DMS.

MODIFIER:

Modifiers used by Wisconsin Medicaid to indicate additional entries of procedure codes associated to the HCPCS codes.

Y — Indicates modifiers specified must always be used when billing for the procedure code.

N — Indicates modifiers are not required when billing for the procedure code but, if listed, may be used if the modifier indicates a more accurate definition of the supply.

IN NH RATE:

YES — Indicates that the item is included in the nursing home daily rate and is not separately reimbursable for nursing home residents.

NO — Indicates this item is not included in the nursing home daily rate and is separately reimbursable for members residing in a nursing home.

IN HC RATE:

YES — Indicates that the item is included in the home care rate and is not separately reimbursable for members receiving home care services. Home care services include covered services provided by home health agencies, personal care agencies, and NIP.

NO — Indicates this item is not included in the home care rate and is separately reimbursable for members receiving home care services.

DESCRIPTION:

Base HCPCS procedure code. The description that appears in the first row of each procedure code is the description that will appear on the RA, regardless of the modifier used. Providers will need to use the DMS Index/Maximum Allowable Fee Schedule with the RA to verify Wisconsin Medicaid's maximum allowable fee payments.

Descriptions may also indicate quantities of each, package, and per box, which is considered one unit. For example, a box may contain multiple items. If "per box of 100" is indicated, the quantity or unit is equal to one (1).

MAX FEE:

Maximum allowable fee for each procedure code and modifier.

MAX QTY/MO:

Quantity allowed per member per calendar month (January, February, March, etc.) unless a different time period is indicated.

CHANGED:

Current DMS Index revisions.
C — Indicates changes.
N — Indicates new information.

COPAY:

The amount of member liability or copayment collected from members by providers and deducted from the payment made to providers by Wisconsin Medicaid.