MedicaidReimbursementHigh impact
Providers are to bill Wisconsin Medicaid their usual and customary charges, Phone number correction, Reporting suspected recipient misuse or abuse of Wisconsin Medicaid benefits, List of agencies and the special managed care program(s) they support, What's new on the Medicaid Web site, Wisconsin Medicaid and BadgerCare Update sent to recipients
Wisconsin Medicaid (ForwardHealth)·WI·Medical Policy
Effective date
Apr 1, 2000
We identified it
Jun 20, 2026
Summary
Wisconsin Medicaid providers must bill their usual and customary charges (the same rates charged to non-Medicaid patients) rather than discounted rates. Wisconsin Medicaid will reimburse the lesser of their maximum allowable fee or the provider's usual and customary charge.
Action Required
Immediately: Billing team must review and update all Wisconsin Medicaid billing to ensure usual and customary charges are being billed (same rates as non-Medicaid patients). For providers using sliding fee scales, bill the median charge for non-Medicaid patients. Update billing system settings and train staff on Terms of Reimbursement requirements. Failure to bill usual and customary charges violates Wisconsin Medicaid certification agreement.