MedicaidReimbursementHigh impact
2025 Hospice Reimbursement Rate Changes
Wisconsin Medicaid (ForwardHealth)·WI · Palliative Care·Billing
Effective date
Oct 1, 2025
We identified it
Sep 29, 2026
Summary
Effective October 1, 2025, ForwardHealth has updated Medicaid and BadgerCare Plus hospice reimbursement rates based on CMS federal rates. The new rates vary by county and service type (routine home care days 1-60, days 61+, continuous care, inpatient respite, and general inpatient care). ForwardHealth will automatically adjust previously paid claims for services on or after the effective date. Billing teams must verify rates by county and service type when submitting or reviewing hospice claims.
Action Required
By September 30, 2025: Billing team must update hospice billing system with new county-based reimbursement rates for all six affected HCPCS codes (T2042, T2043, T2044, T2045, G0155, G0299). Verify that the system distinguishes between routine home care days 1-60 versus days 61+ for code T2042 (0651), and correctly applies service intensity add-on rates (G0155/G0299) for social worker and registered nurse services during the last seven days of life. Ensure member address on file determines rates for T2042, T2043, G0155, and G0299; provider address determines rates for T2044 and T2045. Train billing staff on the new county rate table (Attachments 4-6). Update claim submission validation rules to flag any claims submitted after October 1, 2025 using old rates. Monitor ForwardHealth portal for any managed care organization guidance. Claims submitted with incorrect rates after the effective date may be denied or subject to recoupment.