Electronic Visit Verification (EVV): Service Codes that Require Use of an EVV System in Wisconsin
EVV is federally required for Medicaid-covered personal care, applicable supportive home care, and home health care services. This includes services authorized through Medicaid and BadgerCare Plus fee for service, health maintenance organizations (HMOs), long-term care managed care organizations (MCOs), and IRIS (Include, Respect, I Self-Direct). EVV information will need to be collected for care provided under the following service codes:
Personal care and supportive home care service codes that require EVV in Wisconsin
| Service | Medicaid and BadgerCare Plus Fee-For-Service and BadgerCare Plus and Medicaid Supplemental Security Income (SSI) HMOs | Family Care and Family Care Partnership | IRIS | Live-in Worker Required by DHS to Capture EVV Information* |
|---|---|---|---|---|
| T1019: Personal care services; per 15 minutes | Yes | Yes | Yes | No* |
| T1020: Personal care services; per day | N/A | Yes | No | No* |
| S5125: Supportive home care; per 15 minutes | N/A | Yes | Yes | No* |
| S5126: Supportive home care; per day | N/A | Yes | Yes | No* |
| 99509: Nurse supervisory visit; Home visit for assistance with activities of daily living and personal care; per visit | Yes | Yes | No | Yes |
Home health care service codes that require EVV in Wisconsin
| Service | Medicaid and BadgerCare Plus Fee-For-Service and BadgerCare Plus and Medicaid SSI HMOs | Family Care and Family Care Partnership | IRIS | Live-in Worker Required by DHS to Capture EVV Information* |
|---|---|---|---|---|
| 92507: Treatment of speech, language, voice, communication, and/or auditory processing disorder; per visit | Yes | Yes | No | Yes |
| 97139: Unlisted therapeutic procedure – Occupational therapy; per visit | Yes | Yes | No | Yes |
| 97799: Unlisted physical medicine/rehabilitation service or procedure – Physical therapy; per visit | Yes | Yes | No | Yes |
| 99504: Home visit for mechanical ventilation care; per hour | Yes | Yes | No | Yes |
| 99600: Unlisted home visit service or procedure; per visit | Yes | Yes | No | Yes |
| S9123: Non-vent private duty nursing care in the home – by registered nurse; per hour | Yes | Yes | No | Yes |
| S9124: Non-vent private duty nursing care in the home – by licensed practical nurse; per hour | Yes | Yes | No | Yes |
| T1001: Nursing assessment/evaluation; per visit | Yes | Yes | No | Yes |
| T1021: Home health aide or certified nurse assistant; per visit | Yes | Yes | No | Yes |
| T1502: Administration of oral, intramuscular and/or subcutaneous medication by health care agency/ professional; per visit | Yes | Yes | No | Yes |
*MCOs, HMOs, and provider agencies may independently require live-in workers to use EVV. Fiscal employer agencies for the IRIS program may not require participant-hired live-in workers to use EVV.
The Wisconsin Department of Health Services created two phases for EVV: soft launch and hard launch
- The first phase was called soft launch. During soft launch, EVV was required, but there were no financial consequences if EVV information was missing. Providers (including independent nurses) and workers should have used the soft launch phase to review training, practice using their EVV system, and troubleshoot problems.
- The second phase is called hard launch. Hard launch is when payers began imposing consequences when claims are missing required EVV information. Consequences for providers include claim denial, possible provider enrollment sanctions, and possible IRIS participant disenrollment. Consequences for HMOs and MCOs are exclusion of non-compliant claims from future capitation rate-setting development. Hard launch is required by the federal government for Wisconsin to continue receiving its full federal funding.
EVV timeline
- Hard launch for personal care and supportive home care services began on May 1, 2023.
- Hard launch for home health care services and personal care nurse supervisory visit code 99509 began on October 1, 2024.