• Covered Services
  • Introduction
  • Definition
    • Introduction
    • Program Requirements
  • Emergency Services
  • Services Not Separately Reimbursable
  • Recipient Payment for Covered Services
• Noncovered Services
  • Introduction
  • Definition
  • Recipient Payment for Noncovered Services
    • Introduction
    • Missed Appointments
    • Translation Services
• Collecting Payment from Recipients
  • Introduction
  • Conditions That Must Be Met
• HealthCheck "Other Services"
  • Introduction
  • Prior Authorization
• Appendix
  • Appendix 1 — Services Not Covered by Wisconsin Medicaid
• PDF

Covered and Noncovered Services

Covered Services

Emergency Services

In emergency situations, Wisconsin Medicaid modifies certain program requirements and reimbursement procedures. Emergency services are defined in HFS 101.03(52), Wis. Admin. Code, as “those services which are necessary to prevent the death or serious impairment of the health of the individual.” Wisconsin Medicaid does not reimburse for emergency services unless they are Medicaid-covered services.

Additional definitions and procedures for emergencies exist in other situations, such as dental and mental health. Refer to service-specific publications for more information about program requirements for emergency services.

Program requirements and reimbursement procedures may be modified in the following ways:

• Prior authorization or other program requirements may be waived in emergency situations. Refer to the Prior Authorization section of this handbook and to service-specific publications for more information.
• Noncertified providers may be reimbursed for emergency services. Refer to the Certification and Ongoing Responsibilities section of this handbook for more information.
• Non-U.S. citizens may be eligible for Medicaid-covered services in emergency situations. Refer to the Recipient Eligibility section of this handbook for more information.

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