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2019 CPT and HCPCS Procedure Code Changes
Effective date
Jan 1, 2019
Identified
Jun 20, 2026
Summary
Effective for dates of service on and after January 1, 2019, ForwardHealth updated covered services, policies and service limitations to reflect 2019 CPT and HCPCS code changes for BadgerCare Plus and Medicaid. Behavioral treatment PA requests for dates of service in 2019 must use the new 2019 behavioral treatment CPT codes, while PA requests that include dates of service in both 2018 and 2019 are submitted with 2018 codes, which ForwardHealth converts for dates of service on or after January 1, 2019. Other changes include enddated hearing aid, space maintainer and occlusal guard codes, new imaging codes covered with an approved PA, unit-per-day limits for central nervous system assessments and tests, and a one-unit limit for narcotic treatment drug screens.
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What to do
Action · 12 steps
01Already effective January 1, 2019: Providers must submit new PA requests for dates of service in 2019 with the new 2019 behavioral treatment CPT codes, and PA requests that span 2018 and 2019 with the 2018 codes.
02Providers are required to amend any unused approved PA requests for hearing aid codes V5170, V5180, V5210 or V5220, and for dental codes D1515 or D9940, to reflect the new procedure codes.
03Get an approved PA before billing HCPCS codes L8698, V5171, V5181, V5211 and V5221.
04Bill A5514 without PA for members with a diabetes diagnosis, up to six per year (three right and three left), and bill E0447 without PA at one unit per month.
05Bill D1516 and D1517 without PA, with space maintainers allowable once per year for members through age 20.
06Indicate the fabrication and dispensing of occlusal guards with D9944, D9945 and D9946 on all PA requests and claims.
07Advanced imaging services such as CT, MR, MRE and PET require PA, which is administered by eviCore healthcare, unless the ordering provider is exempt for CT and MR services.
08Report one unit per date of service for narcotic treatment drug screens, since modifier 59 is not recognized as a separate screen.
09Follow the unit-per-day limits listed for CNS assessment and test codes, and follow National Correct Coding Initiative rules.
10Claims for codes 96138 and 96139 by technicians who are not Medicaid-enrolled must be submitted under the supervising provider's NPI.
11Full genome and exome sequencing is not covered.
12Check the Online Handbook and the interactive fee schedules on the Portal for the most current policy and coverage information before acting on these codes.
Codes mentioned
V5170V5180V5210V5220L8698V5171V5181V5211V5221A5514E044781120811218116181162811638116481165811668116781173811748117581176811788117981180811818118281183811848118581187812018120381204812168122281223812348123881239812478124881249812848128581286812878129281294812958129781298813008130281304813128131781319813218132381324813258133481335814008140181402814038140481405814068140781408814108141181413814148143081431814348143781438814398144081442814608146581479815418154581599763917704677047770487704995974959759610196102961039611196118961199612096112961139611696121961309613196132961339613696137961389613996146Q4131Q4186Q4187D1515D9940D1516D1517D9613D9944D9945D9946D9941D7880H0003H0002A651388341883428159567028Q009133477E0470A46269934499345
Original notice
2019 CPT and HCPCS Procedure Code Changes
forwardhealth.wi.gov · Always check the source before changing claims.
Related changes
See all Wisconsin Medicaid (ForwardHealth) changes →2018 CPT and HCPCS Procedure Code ChangesMediumEffective Jan 1, 2018 · Coding2017 CPT and HCPCS Procedure Code ChangesMediumEffective Jan 1, 2017 · Coding2015 CPT and HCPCS Procedure Code ChangesMediumEffective Jan 1, 2015 · CodingPrior Authorization No Longer Required for Certain Advanced Breast Imaging Procedure CodesHighEffective Jul 1, 2026 · Prior AuthorizationBrowse every Wisconsin Medicaid (ForwardHealth) change in the policy list
Related policy hubs
Wisconsin Medicaid (ForwardHealth) policiesWI policy changesAudiologyCardiologyDentistryGeneticsNeurologyOphthalmologyPathologyPediatricsPsychiatryPulmonologyRadiologyWound CareCode V5170Code V5180Code V5210Code V5220Code L8698Code V5171Code V5181Code V5211Code V5221Code A5514Code E0447Code 81120Code 81121Code 81161Code 81162Code 81163Code 81164Code 81165Code 81166Code 81167Code 81173Code 81174Code 81175Code 81176Code 81178Code 81179Code 81180Code 81181Code 81182Code 81183Code 81184Code 81185Code 81187Code 81201Code 81203Code 81204Code 81216Code 81222Code 81223Code 81234Code 81238Code 81239Code 81247Code 81248Code 81249Code 81284Code 81285Code 81286Code 81287Code 81292Code 81294Code 81295Code 81297Code 81298Code 81300Code 81302Code 81304Code 81312Code 81317Code 81319Code 81321Code 81323Code 81324Code 81325Code 81334Code 81335Code 81400Code 81401Code 81402Code 81403Code 81404Code 81405Code 81406Code 81407Code 81408Code 81410Code 81411Code 81413Code 81414Code 81430Code 81431Code 81434Code 81437Code 81438Code 81439Code 81440Code 81442Code 81460Code 81465Code 81479Code 81541Code 81545Code 81599Code 76391Code 77046Code 77047Code 77048Code 77049Code 95974Code 95975Code 96101Code 96102Code 96103Code 96111Code 96118Code 96119Code 96120Code 96112Code 96113Code 96116Code 96121Code 96130Code 96131Code 96132Code 96133Code 96136Code 96137Code 96138Code 96139Code 96146Code Q4131Code Q4186Code Q4187Code D1515Code D9940Code D1516Code D1517Code D9613Code D9944Code D9945Code D9946Code D9941Code D7880Code H0003Code H0002Code A6513Code 88341Code 88342Code 81595Code 67028Code Q0091Code 33477Code E0470Code A4626Code 99344Code 99345