MedicaidBilling CodesHigh impact
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.
Wisconsin Medicaid (ForwardHealth)·WI · Psychiatry, Speech Therapy, Audiology +5 more·Medical Policy
Effective date
Aug 11, 2025
We identified it
Aug 26, 2026
Summary
Effective August 11, 2025, Wisconsin schools can now submit claims for expanded school-based services including mental health, therapy, audiology, nursing, physician, and dental services using new procedure codes. Modifiers are no longer required on school-based services claims (though providers may still include them). The policy has been recently revised with updates noted in red text on pages 1, 2, and 4.
Action Required
By August 11, 2025: Billing team must update billing software to include the new allowable procedure codes for expanded school-based services (mental health, therapy, audiology, nursing, physician, and dental services). Remove modifier requirements from school-based services claim validation rules—modifiers are no longer required but will still be accepted if submitted. Update billing templates and provider documentation to reflect the 31 newly billable codes listed in the policy attachment. Train all staff submitting school-based services claims on the new code set. For schools participating in cost reporting and MAC processes, coordinate with designated district admins on the Wisconsin SBS/MAC Program website to ensure systems are updated for expanded service reporting. Verify that claims submitted for dates of service on or after August 11, 2025 use only codes from the approved list. Failure to comply with code and modifier requirements may result in claim denials or recoupments.