Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 107 - Covered Services › Section DHS 107.03 - Services not covered

Current through June 24, 2024
The following services are not covered services under
				  MA:
(1) Service charges for telephone
				calls;
(2) Charges for missed
				appointments;
(3) Sales tax on
				items for resale;
(4) Services
				provided by a particular provider that are considered experimental in
				nature;
(5) Procedures considered
				by the department to be obsolete, inaccurate, unreliable, ineffectual,
				unnecessary, imprudent or superfluous;
(6) Personal comfort items, such as radios,
				television sets and telephones, which do not contribute meaningfully to the
				treatment of an illness;
(7)
				Alcoholic beverages, even if prescribed for remedial or therapeutic
				reasons;
(8) Autopsies;
(9) Any service requiring prior authorization
				for which prior authorization is denied, or for which prior authorization was
				not obtained prior to the provision of the service except in emergency
				circumstances;
(10) Services
				subject to review and approval pursuant to s.
				150.21, Stats., but which have
				not yet received approval;
(11)
				Psychiatric examinations and evaluations ordered by a court following a
				person's conviction of a crime, pursuant to s.
				972.15, Stats.;
(12) Consultations between or among
				providers, except as specified in s.
				49.45(29y),
				Stats.;
(13) Medical services for
				adult inmates of the correctional institutions listed in s.
				302.01, Stats.;
(14) Medical services for a child placed in a
				detention facility;
(15)
				Expenditures for any service to an individual who is an inmate of a public
				institution or for any service to a person 21 to 64 years of age who is a
				resident of an institution for mental diseases (IMD), unless the person is 21
				years of age, was a resident of the IMD immediately prior to turning 21 and has
				been continuously a resident since then, except that expenditures for a service
				to an individual on convalescent leave from an IMD may be reimbursed by
				MA.
(16) Services provided to
				recipients when outside the United States, except Canada or Mexico;
(17) Separate charges for the time involved
				in completing necessary forms, claims or reports;
(18) Services provided by a hospital or
				professional services provided to a hospital inpatient are not covered services
				unless billed separately as hospital services under s. DHS 107.08 or 107.13 (1)
				or as professional services under the appropriate provider type. No recipient
				may be billed for these services as non-covered;
(19) Services, drugs and items that are
				provided for the purpose of enhancing the prospects of fertility in males or
				females, including but not limited to the following:
(a) Artificial insemination, including but
				not limited to intra-cervical and intra-uterine insemination;
(b) Infertility counseling;
(c) Infertility testing, including but not
				limited to tubal patency, semen analysis or sperm evaluation;
(d) Reversal of female sterilization,
				including but not limited to tubouterine implantation, tubotubal anastomoses or
				fimbrioplasty;
(e)
				Fertility-enhancing drugs used for the treatment of infertility;
(f) Reversal of vasectomies;
(g) Office visits, consultations and other
				encounters to enhance the prospects of fertility; and
(h) Other fertility-enhancing services and
				items;