MedicaidAdministrativeMedium impact
Definition of outpatient hospital services
Wisconsin Medicaid (ForwardHealth)·WI·Medical Policy
Effective date
Sep 1, 2002
We identified it
Jun 20, 2026
Summary
This Wisconsin Medicaid policy clarifies that outpatient hospital rate-per-visit reimbursement is only available for services provided in facilities specifically approved by the Bureau of Quality Assurance (BQA) as hospitals. Freestanding facilities, even if affiliated with or located on the same property as a hospital, must bill under their own Medicaid provider numbers using appropriate claim forms for their service type.
Action Required
Immediately: Wisconsin providers must verify that outpatient services are billed under the correct Medicaid provider number. Services provided in BQA-approved hospital facilities should use the hospital provider number for rate-per-visit reimbursement. Services in freestanding facilities (even if hospital-affiliated) must use the facility's own Medicaid provider number and appropriate claim forms for the service type. Review current billing practices to ensure compliance.