Lead-Safe Wisconsin: Medicaid Reimbursement for Lead-Related Services

Contact your field representative (PDF) to check your program’s HealthCheck provider status.

Visit the ForwardHealth Provider Enrollment page to start or continue Medicaid enrollment.

Find more information about provider enrollment on the ForwardHealth Provider Enrollment Information page.

The local health department becomes certified as a HealthCheck provider, which lets the health department bill for services performed by the department staff.

To bill for a nurse education visit, however, a registered nurse must perform it.

No. Local health departments that are HealthCheck providers may submit certain claims to Medicaid because they are considered enrolled FFS (fee-for-service) Medicaid providers.

A local health department must enroll as a HealthCheck screening provider to bill for lead investigations and education visits.

Local health departments can enroll as HealthCheck providers to do screens, case management, or both.

Local health departments that are enrolled as HealthCheck screeners or HealthCheck case management providers can bill for lead investigations and nurse education visits.

If you used Wisconsin DHS-approved templates for the property investigation or clearance report you created as part of your lead investigation, that will work.

Because the DHS-provided nursing case management form only includes the initial home visit date, we recommend documenting any subsequent education visits, as well.

You can find forms, including environmental investigation and nursing case management templates, on our Lead-Safe Wisconsin: Forms and Publications page.

No. Until the Medicaid reimbursement policy is changed, you can only bill for a child who has a blood lead level of 5 micrograms per deciliter.

You can submit claims:

• Electronically, by using:
  • The ForwardHealth Portal’s online claim submission software.
  • The Provider Electronic Solutions claims submission software.
    • The Division of Medicaid Services (DMS) offers electronic billing software at no cost to the provider. You can download it on the FowardHealth Portal. If you need help installing and using the software, call the Electronic Data Interchange Helpdesk at 866-416-4979.
• By mail or fax with the 1500 Health Insurance Claim Form. ForwardHealth doesn’t provide this form. You can get one from any federal forms supplier.

You can view the most recent reimbursement rates for services in the ForwardHealth max fee schedule.

Submit a claim for the actual amount it cost you to provide the service, even though you’ll only be reimbursed for the maximum fee allowed for that service. Including it will give Medicaid an accurate look at how much it costs to perform the work.

Yes. Medicaid will reimburse for the costs of individual services provided, including:

• In-person and telehealth nurse education visits.
• Initial lead investigations (i.e., lead risk assessments).
• Follow-up investigations (i.e., clearances).

You can then use your funds from the CLPPP consolidated contract for other lead-related activities covered under your contract and for costs not covered fully by the Medicaid reimbursement.

You can’t use funds from the CLPPP consolidated contract for costs that can be reimbursed by Medicaid.

Reach out to your provider field representative (PDF) or to the ForwardHealth Provider Service Call Center at 800-947-9627 for assistance.

Yes, you can bill telehealth nursing education visits; see the December 2021 ForwardHealth Update, “Permanent Telehealth Coverage Policy and Billing Guidelines" (PDF) for more information.

You should include the nursing assessment when billing for the education visit. It’s separate from billing for the lead investigation.

If a nurse conducts both the education visit and the lead investigation, you should bill the services separately.

The billing procedure code (T1002) is for registered nursing services. You can only bill for the nurse education conducted by the registered nurse.

Services you can bill for an environmental health specialist are the initial environmental lead investigation (i.e., risk assessment) and the follow-up investigation (i.e., clearance).

The local health department that employs the certified lead risk assessor submits the claim for the services.

Yes. Medicaid lets local health departments bill for lead investigations performed by certified private lead risk assessors and use the funds to pay them.

Only a certified lead hazard investigator or certified lead risk assessor can perform a clearance investigation. The nurse would also need to be certified as a lead hazard investigator or risk assessor.

No. LeadCheck swabs can’t be used when conducting a lead risk assessment or clearance investigation. You can test paint using an X-ray fluorescence analyzer, or by taking paint chip samples. You can test dust by taking wipe samples.

No. You must collect dust wipe samples when conducting clearance after interior work.

Yes. Submit a claim for the cost of the time spent doing the visual assessment, even though you couldn’t collect dust wipe samples.

You can bill for investigations of two homes when the child regularly spends time at each as part of the parents’ shared custody arrangement.

You can’t bill for other homes for the child, such as a babysitter’s or grandparent’s home, because they’re not considered the child’s residence.

No. The home must be associated with a blood lead level of 5 micrograms per deciliter (µg/dL) or more while the child is living there for Medicaid to cover the risk assessment.

Yes. The local health department can bill for the home’s lead investigation, even if the child no longer lives there.

No. There isn’t a required time period between when the child’s blood lead level is drawn and when the environmental investigation is conducted.

In general, federal grant programs don’t cover things that can be covered by other federal programs.

With the consolidated contract, the funds should only be used to pay for services that aren’t covered by a third party, such as Medicaid.

Always check a grant program’s specific requirements or restrictions.