Wisconsin Telemedicine Policy, Simplified.

Healthcare legislation is complicated. Let’s clarify a few things.

We strive to keep this information updated and current. It is intended to be an informative guide, and not a comprehensive legal resource. Always consult with your local team of experts and administrators.

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Wisconsin Telemedicine Policy

Updated October 2019

Wisconsin Telemedicine Policy

Although Wisconsin doesn’t have a parity law in place, many providers are successfully practicing telemedicine in the Badger State. As part of the Interstate Medical Licensure Compact, Wisconsin has made it easier to practice telehealth across state lines. Keep reading to learn more about Wisconsin’s telemedicine policies!

State Policy Overview

Medicaid
Private Payers
   Parity

Additional state telemedicine information

  • Parity Laws

    A telemedicine parity law requires private payers to reimburse telemedicine services in the same way as in-person services.  Unfortunately, Wisconsin does not currently have a telemedicine parity law in place.

    However, many private payers will still cover certain telehealth services. Check with your private insurance companies!

  • Medicaid

    ForwardHealth, Wisconsin’s Medicaid program, includes telehealth reimbursement through fee-for-service and managed care plans. This program is one of the few nationwide that does not limit where the patient can be located for the virtual visit, extending care to homes and schools. However, Wisconsin Medicaid does place restrictions on the medical services that are covered and which providers are eligible for reimbursement.

  • Type of Telemedicine Covered

    Wisconsin’s Medicaid program currently covers medical and mental health services provided via live video telemedicine. There’s no coverage for store-and-forward or other types of telemedicine solutions at the moment.

  • Covered Health Services

    Wisconsin Medicaid reimburses for a range of telemedicine services, including:

    • Office or other outpatient services
    • Initial inpatient consults
    • Outpatient mental health services
    • Health and behavior assessment/intervention
    • End-stage renal disease-related services
    • Outpatient substance abuse services
    • Crisis intervention services
    • Comprehensive community services
    • Audiology services
    • Community support program services

  • Eligible Healthcare Providers

    Not all healthcare providers can do telemedicine under Wisconsin Medicaid. Here’s the list of the eligible providers:

    • Audiologists
    • Nurse midwives
    • Nurse practitioners
    • Ph.D. psychologists
    • Physician assistants
    • Physicians
    • Psychiatrists
    • Professionals providing services in mental health or substance abuse programs certified by the DQA

  • Online Prescriptions

    Providers can write prescriptions based on a virtual visit, as long as they get the patient’s informed consent, complete a patient evaluation, and prepare a patient record. They should not prescribe medications solely based on an internet questionnaire.

  • Informed Patient Consent

    Wisconsin Medicaid requires providers to get a patient’s informed consent for telemedicine. Learn more about consent best practices here.

  • Cross-State Telemedicine Licensing

    Wisconsin is one of the telemedicine-forward states that belongs to the Interstate Medical Licensing Compact. The compact allows providers in one of the compact states to go through an expedited medical licensing process for any of the other member states. In other words, it’s good news for any providers interested in practicing telemedicine across state lines!

  • Restrictions on Locations

    Wisconsin Medicaid is one of the few nationwide that does not specify where the patient can be located, so homes and schools are eligible as originating sites.

  • Reimbursement Rates

    For most services, ForwardHealth reimburses providers the lesser of the billed amount or the maximum allowable fee on established fee schedules.  

  • Billing Codes

    To bill for telemedicine, just use the appropriate CPT/HCPCS code for the covered health service, along with the “GT” modifier to document that it was provided via telemedicine. You’ll also need to use the place of service (POS) 02 code. 

    Here are just a few of the relevant codes:

    • Office or other outpatient services (99201-99205, 99211-99215) 
    • Office or other outpatient consultations (99241-99245)
    • Initial inpatient consultations (99251-99255)
    • Outpatient mental health services (90785, 90791-90792, 90832-90834, 90836-90840, 90845-90847, 90849, 90875, 90876, and 90887)
    • Health and behavior assessment/intervention (96150-96152, 96154-96155)
    • ESRD-related services (90951-90952, 90954-90958, 90960-90961)
    • Outpatient substance abuse services (H0022H0047T1006)

    Want more details? Check the Wisconsin Medicaid Provider Manual.

  • Helpful Resources

    We used the sites below to gather information for this guide. Check them out for more details on your state’s policy!

Additional resources to help you get started.

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