Wisconsin Billing Guide for Mental Health Therapists and Psychiatrists
Who pays, where to enroll and which rules change your claims in Wisconsin, for psychotherapists and psychiatric prescribers.
Last checked October 25, 2026. Reviewed against the official sources listed at the bottom of this page.
This Wisconsin billing guide covers Medicaid, Medicare, Blue Cross, other private payers and state law for therapists and psychiatrists, with sources and a last-checked date.
Wisconsin billing guide: how Wisconsin pays for outpatient care
Wisconsin Medicaid and BadgerCare Plus are run by the Department of Health Services (DHS) and billed through the ForwardHealth Portal. Members are served through fee-for-service and 13 BadgerCare Plus HMOs. Fee-for-service rules do not automatically bind the HMOs, so check each plan before you bill.
Wisconsin added an Intensive Outpatient Program benefit to Medicaid, billable for dates of service on or after March 1, 2025. DHS says the federal work requirement applies to new BadgerCare Plus applicants from January 1, 2027 and to current members at renewals on or after March 31, 2027.
Who to bill, at a glance
| Payer type | Who you bill | Where to enroll or check rules |
|---|---|---|
| Medicaid (BadgerCare Plus) | DHS; ForwardHealth Portal; 13 BadgerCare Plus HMOs | ForwardHealth Portal |
| Medicare Part B | National Government Services, Jurisdiction 6 | CMS MAC page |
| Blue Cross Blue Shield | Anthem Blue Cross and Blue Shield Wisconsin | See the Blue Cross section below |
Wisconsin Medicaid: Wisconsin Medicaid and BadgerCare Plus
This Wisconsin billing guide starts with Medicaid, because it decides who pays and how you file.
Fee-for-service coexists with BadgerCare Plus and Medicaid SSI HMOs. HMOs must provide at least the same benefits as fee-for-service but set their own policies and rates. Providers must appeal an HMO denial to the HMO first.
No statewide behavioral health carve-out vendor turned up in the sources we reviewed. Behavioral health is covered through outpatient mental health clinics, Comprehensive Community Services, Community Support Programs, DHS 75 certified substance use programs and the Intensive Outpatient Program benefit. HMO members must see in-network providers.
| Item | What to know |
|---|---|
| Agency | Wisconsin Department of Health Services |
| Claims and portal | ForwardHealth Portal. Claims go by CMS-1500, 837P or direct data entry on the portal. Update 2024-38 |
| Fee-for-service filing window | The standard deadline is 365 days from the date of service. Late claims are considered only under defined exceptions with a timely filing appeals request. HMOs set their own rules. ForwardHealth Update 2018-30 |
| Intensive Outpatient Program | Billing began for dates of service on or after 3/1/2025 with H2019 and a program modifier (HE, HF or HH). Prior authorization is required for treatment services. Update 2024-38 |
| Fee schedule | ForwardHealth is discontinuing downloadable maximum allowable fee schedules effective February 1, 2027. Use the interactive Max Fee search. Source |
| Work requirement | New applicants must meet the requirement from January 1, 2027. For current members it applies at renewals on or after March 31, 2027. It applies to BadgerCare Plus adults 19 to 64 who are not pregnant or disabled. Exemptions include medically frail people and people in certain alcohol or drug treatment programs. Providers do not complete DHS forms for medical exemptions. DHS webinar, 7/30/2026 |
Managed-care plans and carve-outs
| Plan or entity | Role in behavioral health |
|---|---|
| Anthem Blue Cross and Blue Shield | One of the 13 BadgerCare Plus HMOs on the DHS list. |
| Chorus Community Health Plans, Dean Health Plan and Group Health Cooperative of Eau Claire | Listed on the DHS HMO page. |
| Group Health Cooperative of South Central Wisconsin and Independent Care Health Plan | Listed on the DHS HMO page. |
| MercyCare, MHS Health Wisconsin and Molina Health Care | Listed on the DHS HMO page. |
| Network Health Plan, Quartz and Security Health Plan of Wisconsin | Listed on the DHS HMO page. |
| UnitedHealthcare Community Plan | Listed on the DHS HMO page. |
Check the DHS HMO page for the current roster and service areas.
Medicare Part B in Wisconsin
For Medicare, this Wisconsin billing guide names your contractor and the current telehealth rules.
Medicare Part B pays for outpatient psychotherapy and psychiatric visits billed to the Medicare Administrative Contractor (MAC) for your state. CMS's July 14, 2026 fact sheet on the CY2027 Physician Fee Schedule proposed rule says the Consolidated Appropriations Act, 2026 extended telehealth payment authority through December 31, 2027, and proposes that in-person visit requirements for mental health visits not apply to services furnished through that date.
| Item | What to know |
|---|---|
| Contractor | National Government Services, Inc. |
| Jurisdiction | Jurisdiction 6: Illinois, Minnesota and Wisconsin |
| Source | CMS.gov MAC page |
Blue Cross Blue Shield in Wisconsin
This part of the Wisconsin billing guide names the exact Blue Cross licensee, because Blue plans never share rules.
Blue Cross Blue Shield is a federation of independent companies, so one licensee's rules never apply to another. In Wisconsin that is Anthem Blue Cross and Blue Shield Wisconsin, an Elevance Health company. Elevance's annual report lists Wisconsin among its Blue licensee states, and the Blue Cross and Blue Shield Association lists it as the Wisconsin company. An Anthem Wisconsin bulletin says its three legal entities are independent licensees. Do not apply another state's Blue rules to Wisconsin.
| Licensee | Parent or affiliation | Where it applies | Provider resources |
|---|---|---|---|
| Anthem Blue Cross and Blue Shield Wisconsin | Elevance Health, Inc. | Wisconsin | Anthem Wisconsin bulletin |
Other private payers and EAPs in Wisconsin
The Wisconsin billing guide also covers commercial plans and employee assistance programs.
These commercial payers and plan families most often matter for behavioral health billing in Wisconsin. Check each payer's current provider manual before you submit.
| Payer | Behavioral health note | Provider resources |
|---|---|---|
| Anthem Blue Cross and Blue Shield Wisconsin | An Anthem bulletin says Blue Cross Blue Shield of Wisconsin handles PPO and indemnity benefits, Compcare handles HMO benefits, and Wisconsin Collaborative Insurance Company handles Well Priority HMO benefits. | Official page |
| Cigna / Evernorth Behavioral Health | The Evernorth administrative guide prefers electronic claims and says EAP claims must use CPT 99404. | Official page |
Wisconsin billing guide: state law that changes billing
Use this section of the Wisconsin billing guide to separate state law from payer policy.
State law sets the floor for commercial plans in Wisconsin. Medicare and Medicaid rules are covered in their own sections above.
Mental health parity
Wis. Stat. 632.89 sets mental health and substance use coverage requirements, as amended by 2009 Wisconsin Act 218. Insurance rule Ins 3.375 implements it: treatment limitations may be no more restrictive than the most common limitations applied to other coverage, and expenses count toward deductibles and out-of-pocket limits. Federal parity applies alongside. Ins 3.375
Telehealth in Medicaid
ForwardHealth Update 2023-01 sets modifier GT for audio-video, 93 for audio-only and GQ for asynchronous, plus behavioral health modifiers FQ and FR. Providers must get member consent. HMOs must provide at least the same benefits as fee-for-service. Update 2023-01
Practitioner scope: therapists
The Marriage and Family Therapy, Professional Counseling and Social Work Examining Board credentials marriage and family therapists, professional counselors and social workers. Board rules
Not legal advice. Confirm statute details with counsel.
Wisconsin billing guide: codes and rates
This Wisconsin billing guide lists only codes and rates confirmed on official pages.
These are the Wisconsin-specific codes, modifiers and rate items confirmed on official pages. Medicare's own CY2027 conversion factor proposal is listed under What changed.
| Code or item | What to know |
|---|---|
| Intensive Outpatient Program codes | H2019 with HE (mental health), HF (substance use) or HH (integrated). U6 marks assessment. Bill 15-minute units with at least 51 percent of the unit completed. Commercial primary insurance is billed with H0015 or S9480 first. Update 2024-38 |
| Continuing care modifier U2 | Effective 12/1/2025 for DHS 75.50 certified programs, not DHS 35 outpatient mental health clinics. Outpatient mental health may be provided at the same time as residential substance use treatment, and only outpatient mental health providers may bill it. Update 2025-33 |
| Telehealth modifiers | GT for interactive audio and video, 93 for real-time audio-only, GQ for asynchronous, FQ and FR for behavioral health. Update 2023-01 |
Wisconsin billing guide: what changed, newest first
Check this Wisconsin billing guide update log before you rely on an older rule.
| Date | What changed | Source |
|---|---|---|
| 2027-02-01 | ForwardHealth discontinues downloadable maximum allowable fee schedules. | Source |
| 2027-01-01 | Work requirement starts for new BadgerCare Plus applicants. | Source |
| 2026-08-01 | DHS mailed work requirement letters to affected BadgerCare Plus adults. | Source |
| 2026-07-14 | CMS released the CY2027 Medicare Physician Fee Schedule proposed rule: conversion factor $32.84 for non-qualifying APM participants (down 1.68%) and $33.17 for qualifying participants (down 1.19%). | Source |
| 2026-06-03 | DHS last revised its BadgerCare Plus HMO page, which lists 13 HMOs. | Source |
| 2025-12-01 | ForwardHealth Update 2025-33 takes effect: continuing care modifier U2 and concurrent outpatient mental health. | Source |
| 2025-03-01 | Medicaid begins paying the Intensive Outpatient Program benefit. | Source |
How do I bill mental health claims in Wisconsin?
These answers come from the same sources as the rest of this Wisconsin billing guide.
Start with the member's payer type. For BadgerCare Plus HMO members, bill the member's HMO. For fee-for-service members, bill ForwardHealth within 365 days of the date of service. Medicare Part B goes to National Government Services in Jurisdiction 6. Anthem Blue Cross and Blue Shield Wisconsin is the Blue licensee for commercial members.
Questions about billing in Wisconsin
Who do I bill for Wisconsin Medicaid behavioral health claims?
Bill the member's BadgerCare Plus HMO, or ForwardHealth for fee-for-service. Appeal HMO denials to the HMO first.
What is the Wisconsin Medicaid timely filing limit?
365 days from the date of service for fee-for-service, with defined exceptions. HMOs set their own rules.
What is the Wisconsin Medicaid Intensive Outpatient Program?
A benefit billable for dates of service on or after March 1, 2025 with H2019 and a program modifier, with prior authorization for treatment services.
When does the Wisconsin Medicaid work requirement start?
January 1, 2027 for new applicants and renewals on or after March 31, 2027 for current members, per DHS.
Does MCM South bill for practices in Wisconsin?
MCM South currently serves ten states; request a quote to ask about Wisconsin.
Sources for the Wisconsin billing guide
Last checked October 25, 2026. Every source below was opened and read on that date.
- Wisconsin DHS, checked October 25, 2026
- ForwardHealth Portal, checked October 25, 2026
- ForwardHealth maximum allowable fee schedules, checked October 25, 2026
- ForwardHealth Update 2024-38, checked October 25, 2026
- ForwardHealth Update 2025-33, checked October 25, 2026
- ForwardHealth Update 2023-01, checked October 25, 2026
- ForwardHealth Update 2018-30, checked October 25, 2026
- DHS BadgerCare Plus HMO information, checked October 25, 2026
- DHS work requirement webinar, July 2026, checked October 25, 2026
- Wis. Admin. Code Ins 3.375, checked October 25, 2026
- Examining Board rules, checked October 25, 2026
- Anthem Wisconsin bulletin, checked October 25, 2026
- Blue Cross and Blue Shield Association companies, checked October 25, 2026
- CMS: MAC Jurisdiction 6, checked October 25, 2026
- CMS: CY2027 Physician Fee Schedule proposed rule fact sheet, checked October 25, 2026
- CMS MAC jurisdiction page, checked October 25, 2026
Related guides
- State & Regional Billing Guides hub
- In-network vs out-of-network credentialing
- Credentialing and network status
- Blue Cross Blue Shield guide for Wisconsin
- Mental health parity explained
- Medicaid managed care billing
- Medicare behavioral health billing
- Timely filing in the billing glossary
- Who we serve
- Illinois insurance companies contact guide
Billing in Wisconsin? Let us handle the payer calls.
MCM South bills only mental and behavioral health, for psychotherapists and psychiatrists, in solo and medium-size practices. We currently serve ten states; request a quote to ask about Wisconsin.
MCM South currently serves practices in ten states: Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois.