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WCA pushes back against Medicaid policy change

Wednesday, May 18, 2016  
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The state Medicaid changes to chiropractic services, which went into effect in October 2015, were originally described by Forward Health as “budget neutral” in terms of compensation.


WCA surveyed members who treat Medicaid patients and the results clearly demonstrate that Wisconsin chiropractors are seeing a noticeable decrease in payment for these patients.

Most concerning: a significant portion of WCA members are considering reducing the number of Medicaid patients they treat, or ceasing to accept any Medicaid patients at all


The state’s decision to discontinue coverage of procedure code 99201 (office or other outpatient visit for the evaluation and management of a new patient) contradicts the Wisconsin Administrative Code, which supports the use of an initial office visit and establishes the “competent assessment, evaluation or diagnosis” as a required professional standard of conduct.  


At a time when other states are expanding Medicaid coverage of chiropractic treatment due to its cost effective nature and demonstrated results, the WCA is perplexed by the rationale behind the reduction of chiropractic benefits.


The WCA also doubts how this will lead to increased savings and improved outcomes for Medicaid patients in Wisconsin, and suggests a more prudent approach.



WCA Proposal


In order to truly remain budget neutral, the WCA proposes Forward Health rescind the October 1, 2015 policy change that made 99201 a non-covered service. Instead, Forward Health should recognize all billable E/M CPT codes (99201-99205 as well as 99211-99215), and reimburse them all at the former amount which 99201 was reimbursed at as of September 30, 2015.





This will increase the accuracy of claims by allowing a chiropractor to indicate whether a patient is new or existing, as well as the relative complexity of the office visit itself. This will in turn allow Forward Health to better identify chronic pain patients or those necessitating longer treatment plans for more complicated injuries and symptoms.