MedicaidBilling CodesHigh impact
Changes to Claims Submission Requirements for Outpatient Hospital Services
Wisconsin Medicaid (ForwardHealth)·WI·Medical Policy
Effective date
Jan 1, 2016
We identified it
Jun 20, 2026
Summary
ForwardHealth is implementing new place of service (POS) codes for outpatient hospital services effective January 1, 2016. POS code 19 must now be used for off-campus outpatient hospital services, POS code 22 is revised for on-campus services, and modifier PO is now mandatory on institutional claims for off-campus services (though these will be denied per Wisconsin's '4 walls policy').
Action Required
Effective January 1, 2016: Billing team must update place of service codes in billing system - use POS code 19 for off-campus outpatient hospital services and POS code 22 for on-campus outpatient hospital services. Stop submitting institutional claims with modifier PO for off-campus services as these will be denied under Wisconsin Medicaid's '4 walls policy'. Update billing software rules and train staff on new POS code requirements.