DHS 107.24(5)(g)(g) Repair, maintenance or modification of rented durable medical equipment;
DHS 107.24(5)(h)(h) Delivery or set-up charges for equipment as a separate service;
DHS 107.24(5)(i)(i) Fitting, adapting, adjusting or modifying a prosthetic or orthotic device or corrective or orthopedic shoes as a separate service;
DHS 107.24(5)(j)(j) All repairs of a hearing aid or other assistive listening device performed by a dealer within 12 months after the purchase of the hearing aid or other assistive listening device. These are included in the purchase payment and are not separately reimbursable;
DHS 107.24(5)(k)(k) Hearing aid or other assistive listening device batteries which are provided in excess of the guidelines enumerated in the MA speech and hearing provider handbook;
DHS 107.24(5)(L)(L) Items that are provided for the purpose of enhancing the prospects of fertility in males or females;
DHS 107.24(5)(m)(m) Impotence devices, including but not limited to penile prostheses;
DHS 107.24(5)(n)(n) Testicular prosthesis;
DHS 107.24(5)(o)(o) Food; and
DHS 107.24(5)(p)(p) Infant formula and enteral nutritional products except as allowed under s. DHS 107.10 (2) (c).
DHS 107.24 HistoryHistory: Cr. Register, February, 1986, No. 362, eff. 3-1-86; emerg. r. and recr. (3) (h) 1. and 2., eff. 7-1-89; am. (2) (d) 6., (3) (e), (h) 4., (4) (c) 2., (5) (j) and (k), r. and recr. (3) (h) (intro.), 1. and 2. and (4) (g), cr. (4) (h), Register, May, 1990, No. 413, eff. 6-1-90; r. and recr. (4) (a), Register, September, 1991, No. 429, eff. 10-1-91; am. (5) (j) to (k), cr. (5) (L) to (p), Register, January, 1997, No. 493, eff. 2-1-97; correction in (4) (b) made under s. 13.93 (2m) (b) 7., Stats., Register February 2002 No. 554; CR 03-033: am. (2) (a), (3) (h) 1. (intro.), 2., and (5) (j) Register December 2003 No. 576, eff. 1-1-04; CR 20-012: renum. (1) to (1) (intro.) and am., cr. (1) (b), am. (2) (a), cr. (2) (a) 2., am. (2) (c) 1., 4., 6., cr. (2) (c) 9., am. (3) (intro.), (a) to (g), (h) 1. to 3., cr. (3) (i), (j), (4) (i), am. (5) (b) Register October 2021 No. 790, eff. 11-1-21; correction in (3) (g) made under s. 35.17, Stats., Register October 2021 No. 790; CR 20-039: am. (2) (c) 1., 4. to 6. Register October 2021 No. 790, eff. 11-1-21; merger of (2) (c) 1., 4., 6. treatments by CR 20-012 and CR 20-039 made under s. 13.92 (4) (bm), Stats., Register October 2021 No. 790; correction in (2) (a) 1. made under s. 35.17, Stats., Register December 2021, No. 792; CR 22-043: Register May 2023 No. 809, eff. 6-1-23; CR 23-005: am. (4) (c) 1., renum. (4) (c) 2. to (4) (c) 2. (intro.) and am., cr. (4) (c) 2. a. to c., r. (4) (c) 3. Register April 2024 No. 820, eff. 5-1-24; merger of (2) (c) 1., 4., 6. treatments by CR 20-012 and CR 23-046 and merger of (2) (c) 1., 4. to 6. treatments by CR 20-012, CR 20-039, and CR 23-046 made under s. 13.92 (4) (bm), Stats., Register April 2024 No. 820.
DHS 107.25DHS 107.25Diagnostic testing services.
DHS 107.25(1)(1)Covered services. Professional and technical diagnostic services covered by MA are laboratory services provided by a certified physician or under the physician’s supervision, or prescribed by a physician and provided by an independent certified laboratory, and x-ray services prescribed by a physician and provided by or under the general supervision of a certified physician.
DHS 107.25(2)(2)Other limitations.
DHS 107.25(2)(a)(a) All diagnostic services shall be prescribed or ordered by a physician or dentist.
DHS 107.25(2)(b)(b) Laboratory tests performed which are outside the laboratory’s certified areas are not covered.
DHS 107.25(2)(c)(c) Portable x-ray services are covered only for recipients who reside in nursing homes and only when provided in a nursing home.
DHS 107.25(2)(d)(d) Reimbursement for diagnostic testing services shall be in accordance with limitations set by P.L. 98-369, Sec. 2303.
DHS 107.25 HistoryHistory: Cr. Register, February, 1986, No. 362, eff. 3-1-86.
DHS 107.26DHS 107.26Dialysis services. Dialysis services are covered services when provided by facilities certified pursuant to s. DHS 105.45.
DHS 107.26 HistoryHistory: Cr. Register, February, 1986, No. 362, eff. 3-1-86; correction made under s. 13.92 (4) (b) 7., Stats., Register December 2008 No. 636.
DHS 107.27DHS 107.27Blood. The provision of blood is a covered service when provided to a recipient by a physician certified pursuant to s. DHS 105.05, a blood bank certified pursuant to s. DHS 105.46 or a hospital certified pursuant to s. DHS 105.07.
DHS 107.27 HistoryHistory: Cr. Register, February, 1986, No. 362, eff. 3-1-86; correction made under s. 13.92 (4) (b) 7., Stats., Register December 2008 No. 636.
DHS 107.28DHS 107.28Health maintenance organization and prepaid health plan services.
DHS 107.28(1)(1)Covered services.
DHS 107.28(1)(a)(a) HMOs.
DHS 107.28(1)(a)1.1. Except as provided in subd. 2., all health maintenance organizations (HMOs) that contract with the department shall provide to enrollees all MA services that are covered services at the time the medicaid HMO contract becomes effective with the exception of the following:
DHS 107.28(1)(a)1.a.a. EPSDT outreach services;
DHS 107.28(1)(a)1.b.b. County transportation by common carrier;