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Claims Submission Information for Expanded School-Based ServicesMay 15, 2026: This Update has been revised since its original publication. Revised information appears in red text on pages 1, 2, and 4.
Effective date
Aug 11, 2025
Identified
Aug 26, 2026
Summary
Effective for dates of service on and after August 11, 2025, schools that provide school-based services can submit claims to ForwardHealth for an expanded set of procedure codes. The new codes cover psychological, counseling, social work, and mental and behavioral health services, therapy and audiology services, nursing and physician services, and dental services. Modifiers are no longer required on school-based services claims for those dates of service, although allowable modifiers are still accepted, and other claims submission requirements have not changed.
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What to do
Action · 7 steps
01Already effective August 11, 2025: Submit claims for expanded school-based services using the procedure codes in the Attachment for dates of service on and after August 11, 2025, and check the interactive maximum allowable fee schedule on the Portal for the complete list of allowable codes.
02Modifiers are no longer required on school-based services claims, but allowable modifiers can still be included.
03Providers that share a service area with BadgerCare Plus HMOs must attempt to sign a joint memorandum of understanding and communicate with each other to coordinate care for students.
04Follow the documentation retention requirements in Wis.
05Admin.
06Code DHS 106.02(9) and produce documentation to DHS on request, since refusal to produce documentation may result in denial of submitted claims, recoupment of paid claims, intermediate sanctions, or termination from the Medicaid program.
07Submit cost reporting and Medicaid Administrative Claiming through the Wisconsin SBS/MAC Program website, which requires a login.
Codes mentioned
90791908329083490837908399084690847H0001H0002H0004H0005H0031H0034H2000H2011S94849252692551925529255392555925569255797533991739920299203992049920599212992139921499215V2799D0140D0191D1206D1208D1351
Original notice
Claims Submission Information for Expanded School-Based ServicesMay 15, 2026: This Update has been revised since its original publication. Revised information appears in red text on pages 1, 2, and 4.
forwardhealth.wi.gov · Always check the source before changing claims.
Related changes
See all Wisconsin Medicaid (ForwardHealth) changes →ForwardHealth Enhances Behavioral Health Treatment With More Options for Continuing Care and Concurrent ServicesHighEffective Dec 1, 2025 · Medical Policy2018 CPT and HCPCS Procedure Code ChangesMediumEffective Jan 1, 2018 · CodingNew Place of Service Code for Narcotic Treatment Services ProvidersHighEffective Aug 17, 2026 · Medical PolicyMental Health and Substance Abuse Screening, Preventive Mental Health Counseling, and Substance Abuse Intervention for Pregnant Women: A New Benefit Under BadgerCare Plus and Wisconsin MedicaidMediumNo effective date · Medical PolicyBrowse every Wisconsin Medicaid (ForwardHealth) change in the policy list
Related policy hubs
Wisconsin Medicaid (ForwardHealth) policiesWI policy changesAudiologyDentistryOccupational TherapyPhysical TherapySpeech TherapyGeneral PracticeCode 90791Code 90832Code 90834Code 90837Code 90839Code 90846Code 90847Code H0001Code H0002Code H0004Code H0005Code H0031Code H0034Code H2000Code H2011Code S9484Code 92526Code 92551Code 92552Code 92553Code 92555Code 92556Code 92557Code 97533Code 99173Code 99202Code 99203Code 99204Code 99205Code 99212Code 99213Code 99214Code 99215Code V2799Code D0140Code D0191Code D1206Code D1208Code D1351