MedicaidCoverageHigh impact
ForwardHealth Enhances Behavioral Health Treatment With More Options for Continuing Care and Concurrent Services
Wisconsin Medicaid (ForwardHealth)·WI · Psychiatry, Family Medicine, Internal Medicine +1 more·Medical Policy
Effective date
Dec 1, 2025
We identified it
Sep 29, 2026
Summary
ForwardHealth expands behavioral health coverage effective December 1, 2025 by: (1) adding continuing care coverage for members discharged from outpatient SUD treatment programs with a new U2 modifier requirement, (2) allowing concurrent outpatient mental health services with residential SUD treatment, (3) permitting medication management through CCS alongside residential SUD treatment, and (4) reimbursing point-of-care drug testing within IOP programs. Billing teams must implement the new U2 modifier for continuing care claims and update documentation workflows to reflect concurrent service eligibility.
Action Required
By December 1, 2025: (1) Billing team must update billing system to recognize and require the new U2 modifier for all continuing care claims using procedure codes H0005, H0022, H0047, T1006, 90832, 90834, 90837, 90846, 90847, and 90853. This applies only to DHS 75.50-certified programs, not DHS 35 outpatient mental health clinics. (2) Clinical documentation templates must be updated to include discharge plans documenting continuing care services (planned vs. unplanned) and whether members may receive services from any clinician within the same agency. (3) Providers must remove reassessment/intake/assessment requirements from workflows for eligible continuing care members (same agency within 1 year of discharge). (4) Update prior authorization workflows to recognize that concurrent services do not automatically require PA, but individual services that normally require PA must still be authorized per their respective policies. (5) Billing team must configure system to allow concurrent billing when members receive both outpatient mental health and residential SUD treatment, ensuring non-duplicative, medically necessary services. (6) For IOP programs: update billing to recognize point-of-care drug testing as a reimbursable service. Failure to apply U2 modifier or implement continuing care documentation changes will result in claim denials.