MedicaidBilling CodesHigh impact
ForwardHealth Update 2025-39: New Per Diem Crisis Stabilization Service Tiers and Billing Modifiers
Wisconsin ForwardHealth·WI · Psychiatry·Claims & Billing
Effective date
Jan 1, 2026
We identified it
Jun 18, 2026
Summary
ForwardHealth is implementing a new 3-tier reimbursement structure for crisis stabilization services with increased per diem rates and new billing modifiers. Hourly billing is limited to 8 hours per date of service, after which providers must use per diem billing with appropriate tier-specific modifiers.
Action Required
By January 1, 2026: Billing team must update system to use new tier-specific modifiers for crisis stabilization services - no modifier for community-based (Tier 1), TF modifier for crisis-dedicated (Tier 2), and HA modifier for youth crisis facilities (Tier 3). Update billing rules to automatically switch from hourly S9484 to per diem S9485 after 8 hours per date of service. Train staff on new 3-tier structure and location requirements. Claims without proper modifiers may be denied or incorrectly reimbursed.