Wis. ForwardHealth Online Handbook, Hospice, Topic #897

Maximum allowable fee information is available on the Max Fee Schedules page of the ForwardHealth Portal in the following

forms:

• An interactive maximum allowable fee schedule

• Downloadable fee schedules by service area only in TXT (text) or CSV (comma separated value) files

Policy information is not displayed in the fee schedules. Providers should refer to their specific service area in the Online

Handbook for more information about coverage policy related to a specific procedure code.

Certain fee schedules are interactive. On the interactive fee schedule, providers have more search options for looking up some

coverage information, as well as the maximum allowable fees, as appropriate, for reimbursable HCPCS (Healthcare Common

Procedure Coding System), CPT (Current Procedural Terminology), or CDT (Current Dental Terminology) procedure codes for

most services.

Providers have the ability to independently search by:

• A single HCPCS, CPT, or CDT procedure code

• Multiple HCPCS, CPT, or CDT procedure codes

• A pre-populated code range

• A service area (Service areas listed in the interactive fee schedule more closely align with the provider service areas listed in

the Online Handbook, including the WCDP (Wisconsin Chronic Disease Program) programs and WWWP (Wisconsin

Well Woman Program).)

The downloadable fee schedules, which are updated monthly, provide basic maximum allowable fee information by provider

service area.

Through the interactive fee schedule, providers can export their search results for a single code, multiple codes, a code range, or

by service area. The export function of the interactive fee schedule will return a .zip file that includes seven CSV files containing

the results.

Note: The interactive fee schedule will export all associated information related to the provider's search criteria except the

procedure code descriptions.

Providers may call Provider Services in the following cases:

• The ForwardHealth Portal is not available.

• There is uncertainty as to which fee schedule should be used.

• The appropriate fee schedule cannot be found on the Portal.

• To determine coverage or maximum allowable fee of procedure codes not appearing on a fee schedule.