MedicaidReimbursementHigh impact
ForwardHealth Reimbursement Rate Increases
Wisconsin Medicaid (ForwardHealth)·WI · Dentistry, OB-GYN, Psychiatry +3 more·Billing
Effective date
Jan 1, 2026
We identified it
Sep 29, 2026
Summary
ForwardHealth (Wisconsin Medicaid/BadgerCare Plus) is increasing maximum allowable reimbursement rates for 7 service categories effective January 1, 2026, including dental anesthesia, home health visits, narcotic treatment services, obstetrics, personal care services, private duty nursing, and residential substance use disorder treatment. Billing teams must update fee schedules and ensure claims reflect the new rates starting 2026.
Action Required
By December 31, 2025: Billing team must update all fee schedules in the billing system to reflect new ForwardHealth maximum allowable rates effective January 1, 2026. Download updated fee schedules from the ForwardHealth Portal Max Fee Schedule Dynamic Search on January 1, 2026. Verify that claims for the following services use correct new rates: dental anesthesia (D9222, D9223, D9239, D9243 at $238.00 per 15-minute unit, max 10 units), home health visits (99600 at $117.86), methadone administration (H0020 with modifier U1 at $16.91), obstetric delivery services (59400 and 59510 at $1,356.20; 59610 at $1,442.61), personal care services (T1019 at $6.26 per 15 minutes), private duty nursing (99504 with modifiers TD/TE at $75.00/$61.05 per hour for RN/LPN ventilator care; S9123/S9124 at $67.55/$55.00 per hour for non-ventilator care), and residential SUD treatment (H0018 with modifiers TF/TG at $102.84/$228.53 per diem). Claims submitted on or after January 1, 2026 with outdated rates will be denied or subject to recoupment. Ensure providers and staff are notified of rate changes in advance of the effective date.