What types of policy changes does Wisconsin ForwardHealth issue?

Wisconsin ForwardHealth regularly publishes coverage updates including prior authorization requirement changes, billing code additions or deletions, plan-type coverage modifications, and clinical policy revisions. PolicyChanges.app monitors these notices and summarizes the impact for providers.

How often does Wisconsin ForwardHealth update its policies?

Wisconsin ForwardHealth typically releases policy bulletins on a rolling basis throughout the year. Our system checks for new updates daily and adds them to this feed as soon as they are identified.

How many Wisconsin ForwardHealth policy changes are tracked here?

This page currently tracks 31 documented Wisconsin ForwardHealth policy changes. New items are added as they are identified.

What should I do when Wisconsin ForwardHealth changes a prior authorization policy?

Review each change's effective date and action-required notes. Update your billing and clinical workflows before the effective date to avoid claim denials. Each policy detail page on PolicyChanges.app includes a plain-English summary and action items.

Wisconsin ForwardHealth Policy Changes & Prior Auth Updates

We track 31 documented policy changes from Wisconsin ForwardHealth across WI. Each entry includes an AI-generated plain-English summary, effective date, affected billing codes, and a direct link to the original Wisconsin ForwardHealth notice. Use the related links below to narrow results by specialty or state, or sign up for a free daily alert to receive new Wisconsin ForwardHealth updates automatically.

High impact
ForwardHealth Update 2025-26: ForwardHealth Vaccine Coverage: New Sources of Vaccine Recommendations and Revised Billing for COVID-19, Influenza, and Measles, Mumps, Rubella, and Varicella VaccinesDecember 2, 2025: This Update has been revised since its original publication. Revised information appears in red text on page 3.
Wisconsin ForwardHealth·Effective Nov 1, 2025
ForwardHealth (Wisconsin Medicaid) is expanding vaccine coverage beyond CDC recommendations and implementing new billing processes for COVID-19, influenza, and MMRV vaccines effective November 1, 2025. Claims for these vaccines submitted October 1-31 will be suspended and automatically processed November 1.
Medium impact
ForwardHealth Update 2025-27: Prior Authorization Changes for Certain Preferred Drug List Classes, Anti-Obesity Drugs, and Other Pharmacy Policy Effective November 1, 2025
Wisconsin ForwardHealth·Effective Nov 1, 2025
ForwardHealth (Wisconsin Medicaid) is implementing new prior authorization requirements for several drug classes effective November 1, 2025, including Alzheimer's agents (Leqembi IQLIK), bone resorption drugs (Bonsity and teriparatide), oral glucocorticoids (Jaythari and Pyquvi), and anti-obesity medications. These changes require specific clinical documentation and PA forms to be submitted through pharmacies.
Medium impact
ForwardHealth Update 2025-28: ForwardHealth Reimbursement Rate Increases
Wisconsin ForwardHealth·Effective Jan 1, 2026
ForwardHealth (Wisconsin Medicaid/BadgerCare Plus) has increased reimbursement rates for multiple service categories including dental anesthesia, home health visits, obstetrics, personal care, private duty nursing, narcotic treatment, and residential substance abuse treatment services. The updated fee schedules will be available on the ForwardHealth Portal.
High impact
ForwardHealth Update 2025-29: Severe Malocclusion Policy Clarification
Wisconsin ForwardHealth·Effective Oct 31, 2025
ForwardHealth is replacing the Salzmann Index scoring system with new orthodontic automatic qualifiers (AQs) to determine medically necessary orthodontic care for severe malocclusions. The new criteria include specific conditions like cleft palate, severe overjet, crossbites, and skeletal malocclusions that automatically qualify for coverage.
Low impact
ForwardHealth Update 2025-30: Dental Therapists May Enroll With Wisconsin Medicaid and Bill as Separate ProvidersDecember 16, 2025: This Update has been revised since its original publication. Information about restorative services dental therapists may provide has been clarified. See page 7 of the Update for more information.
Wisconsin ForwardHealth·Effective Jan 1, 2026
Beginning January 1, 2026, dental therapists can now enroll separately with Wisconsin Medicaid to provide and bill for preventive, restorative, and periodontal dental services. This creates a new provider category that can submit independent claims for covered dental services.
Medium impact
ForwardHealth Update 2025-31: ForwardHealth Holiday Schedule
Wisconsin ForwardHealth·Effective Nov 27, 2025
ForwardHealth (Wisconsin Medicaid programs) has updated their holiday schedule for 2025-2026, specifying when offices are closed and how holidays affect claim submission deadlines and payment processing. Claims must still meet weekly processing deadlines, and payment delays of one day will occur depending on which day of the week holidays fall.
Medium impact
ForwardHealth Update 2025-32: 2025 Hospice Reimbursement Rate Changes
Wisconsin ForwardHealth·Effective Oct 1, 2025
ForwardHealth updated Wisconsin Medicaid and BadgerCare Plus hospice reimbursement rates effective October 1, 2025, with county-specific rates for routine care, continuous care, inpatient respite, and general inpatient services. ForwardHealth will automatically adjust previously paid claims for services provided on and after the effective date.
Medium impact
ForwardHealth Update 2025-33: ForwardHealth Enhances Behavioral Health Treatment With More Options for Continuing Care and Concurrent Services
Wisconsin ForwardHealth·Effective Dec 1, 2025
ForwardHealth (Wisconsin Medicaid) expands behavioral health treatment options effective December 1, 2025, adding continuing care coverage for discharged SUD patients and allowing concurrent outpatient mental health services with residential SUD treatment. A new U2 modifier is required for billing continuing care services.
High impact
ForwardHealth Update 2025-34: Prescribing, Referring, and Ordering Permissions UpdatedDecember 15, 2025: This Update has been revised since its original publication. Revised information appears in red text on page 1.
Wisconsin ForwardHealth·Effective Dec 1, 2025
Effective December 1, 2025, any Medicaid-enrolled provider acting within their scope of practice may now prescribe, refer, and order medical services and drugs - previously only physicians could do this. This significantly expands prescribing and ordering authority to nurse practitioners, physician assistants, therapists, and other qualified providers for Wisconsin Medicaid and BadgerCare Plus programs.
High impact
ForwardHealth Update 2025-35: Prior Authorization Process Improvements: Overview
Wisconsin ForwardHealth·Effective Jan 1, 2026
ForwardHealth is implementing prior authorization process improvements for Wisconsin Medicaid and BadgerCare Plus in two phases: January 1, 2026 brings new urgent PA identification requirements, clearer denial messages, new PA status categories, and a revised fax cover sheet; January 1, 2027 establishes mandatory processing timeframes of 72 hours for urgent and 7 days for non-urgent requests.
Medium impact
ForwardHealth Update 2025-36: January 2026 Preferred Drug List Changes and Other Pharmacy PolicyJanuary 6, 2026: This Update has been revised since its original publication. Revised information appears in red text on pages 10, 29, and 33-34.
Wisconsin ForwardHealth·Effective Jan 1, 2026
ForwardHealth (Wisconsin Medicaid) updated their Preferred Drug List effective January 1, 2026, adding new drug classes and changing prior authorization requirements for multiple medications. Two new antibiotics (Blujepa and Orlynvah) now require clinical prior authorization with specific criteria for female patients with uncomplicated UTIs.
Medium impact
ForwardHealth Update 2025-37: Changes for Casgevy and Lyfgenia and Other Polices in the New Cell and Gene Therapy Access Model for Members With Sickle Cell Disease
Wisconsin ForwardHealth·Effective Jan 1, 2026
Wisconsin ForwardHealth (BadgerCare Plus/Medicaid) is implementing the Cell and Gene Therapy Access Model for sickle cell disease treatments Casgevy and Lyfgenia, with revised clinical criteria and prior authorization requirements. Members participating in the model will be permanently exempted from HMO enrollment requirements.
High impact
ForwardHealth Update 2025-38: Prior Authorization Process Improvements: Removing Spell of Illness and Revising Limits for Therapy ServicesFebruary 9, 2026: This Update has been revised since its original publication. Audiologists will now receive the ForwardHealth Update, two ForwardHealth Online Handbook topics were added to the Quick Links section, and information about Individualized Education Plan (IEP) submissions was added. Revised information appears in red text on pages 1 and 2.
Wisconsin ForwardHealth·Effective Jan 1, 2026
Effective January 1, 2026, ForwardHealth is discontinuing the spell of illness policy for PT, OT, and SLP services and changing from a lifetime limit to an annual limit of 35 visits per discipline before prior authorization is required. Providers must use new process types and updated forms for all prior authorization requests.
High impact
ForwardHealth Update 2025-39: New Per Diem Crisis Stabilization Service Tiers and Billing Modifiers
Wisconsin ForwardHealth·Effective Jan 1, 2026
ForwardHealth is implementing a new 3-tier reimbursement structure for crisis stabilization services with increased per diem rates and new billing modifiers. Hourly billing is limited to 8 hours per date of service, after which providers must use per diem billing with appropriate tier-specific modifiers.
Low impact
ForwardHealth Update 2025-40: Expanding Tribal Federally Qualified Health Center Shared Savings
Wisconsin ForwardHealth·Identified Jun 18, 2026
ForwardHealth is implementing a new Tribal Shared Savings program that allows outside providers with signed care coordination agreements with Tribal FQHCs to receive 100% Federal Medical Assistance Percentage (FMAP) for services to Native American/Alaska Native Medicaid members. Providers must include the Tribal FQHC's National Provider Identifier or Medicaid Provider ID in the Referring Provider or Referral Number fields when submitting claims.
Medium impact
ForwardHealth Update 2025-41: Behavioral Treatment Benefit Policy Clarifications and ForwardHealth Online Handbook Revisions
Wisconsin ForwardHealth·Identified Jun 18, 2026
ForwardHealth has updated behavioral treatment benefit policies for Wisconsin Medicaid and BadgerCare Plus following a federal audit. Changes include new documentation requirements, clarified non-covered services, and new topics for adaptive behavior treatment protocols and concurrent billing.
Low impact
ForwardHealth Update 2025-42: Reimbursement Increase for Nurse Aide Training and Testing
Wisconsin ForwardHealth·Effective Jan 1, 2026
ForwardHealth (Wisconsin Medicaid) is significantly increasing reimbursement rates for certified nursing assistant (CNA) training and testing costs effective January 1, 2026. Training reimbursement increases from $225 to $700, and competency testing increases from $61.50 to $135.
High impact
ForwardHealth Update 2026-01: ForwardHealth Expands Vaccine Billing Process Changes
Wisconsin ForwardHealth·Effective Feb 1, 2026
ForwardHealth is expanding vaccine billing requirements effective February 1, 2026. All providers must now include both vaccine product codes AND administration codes on all vaccine claims, and must add the SL modifier for vaccines supplied through the federal Vaccines for Children (VFC) Program.
Low impact
ForwardHealth Update 2026-02: Tribal Federally Qualified Health Centers Can Bill Pharmacy Visits as Encounters
Wisconsin ForwardHealth·Effective Jan 1, 2026
Effective January 1, 2026, Tribal Federally Qualified Health Centers (FQHCs) in Wisconsin can now bill pharmacy visits as encounters under their All-Inclusive Rate (AIR) reimbursement option. This new policy allows Tribal FQHCs to receive encounter payments for covered outpatient drugs dispensed by their pharmacies, addressing ingredient costs previously excluded from FQHC encounter payments.
Medium impact
ForwardHealth Update 2026-03: Revised Billing for Tribal Federally Qualified Health Centers
Wisconsin ForwardHealth·Effective Jan 1, 2024
ForwardHealth (Wisconsin Medicaid) has changed reimbursement for Tribal Federally Qualified Health Centers from a cost-settlement process to either Prospective Payment System (PPS) or All-Inclusive Rate (AIR) options. Tribal FQHCs must now use HCPCS code T1015 for billing encounters and can choose their reimbursement method annually.
Medium impact
ForwardHealth Update 2026-04: March 2026 Changes for Certain Preferred Drug List Classes and Other Pharmacy Policy
Wisconsin ForwardHealth·Effective Mar 1, 2026
ForwardHealth (Wisconsin Medicaid) is implementing new prior authorization requirements and clinical criteria for antibiotics (Blujepa/Orlynvah) and lipotropics (Redemplo/Tryngolza), plus policy changes for spinal muscular atrophy drugs. New forms and stricter documentation requirements take effect March 1, 2026.
Medium impact
ForwardHealth Update 2026-05: New Coverage for Peer Recovery Support Services
Wisconsin ForwardHealth·Effective Apr 1, 2026
ForwardHealth (Wisconsin Medicaid) is introducing new coverage for Peer Recovery Support Services (PRS) starting April 1, 2026. These are non-clinical behavioral health support services provided by peer recovery coaches, with members eligible for up to 520 hours per calendar year.
Low impact
ForwardHealth Update 2026-06: Tribal Federally Qualified Health Centers Can Receive All-Inclusive Rate Reimbursement for Compound Drug Claims
Wisconsin ForwardHealth·Effective Mar 23, 2026
Effective March 23, 2026, Tribal Federally Qualified Health Centers (FQHCs) that choose the all-inclusive rate (AIR) will receive AIR reimbursement for compound drug claims submitted to ForwardHealth for BadgerCare Plus and Medicaid members. The AIR includes all ingredient costs and dispensing fees, with no separate dispensing or repackaging fees reimbursed.
Medium impact
ForwardHealth Update 2026-07: CPT, HCPCS, and CDT Procedure Code Changes Effective January 1, 2026
Wisconsin ForwardHealth·Effective Jan 1, 2026
ForwardHealth updated CPT, HCPCS, and CDT procedure codes effective January 1, 2026 for Wisconsin Medicaid and BadgerCare Plus programs. Two HCPCS codes (G0511 and G0512) were discontinued for community health centers, and suspended claims from the delayed implementation are now being processed automatically.
High impact
ForwardHealth Update 2026-08: For Prenatal Care Coordination Providers: Milwaukee County Transition and Statewide Changes to Memoranda of Understanding Requirement
Wisconsin ForwardHealth·Effective Jan 1, 2027
Beginning January 1, 2027, prenatal care coordination (PNCC) providers serving Medicaid members in Milwaukee County must contract directly with Wisconsin Medicaid HMOs and Partnership MCOs for reimbursement instead of billing ForwardHealth fee-for-service. Additionally, memoranda of understanding (MOU) requirements for PNCC providers have been eliminated statewide.
High impact
ForwardHealth Update 2026-09: Prior Authorization Process Improvements: Revising the Prior Authorization Request Form, Vision Procedure Codes, and Prior Authorization RequirementsApril 17, 2026: This Update has been revised since its original publication. Information regarding the dental and orthodontic exception for PA requests requiring physical 3D models has been corrected on page 1 and 2.
Wisconsin ForwardHealth·Effective Jul 13, 2026
ForwardHealth (Wisconsin Medicaid) is eliminating fax and mail prior authorization submissions effective July 13, 2026, requiring all PA requests be submitted electronically through their Portal. The policy also implements a universal 14-day backdating policy and removes certain vision procedure codes from PA requirements.
Medium impact
ForwardHealth Update 2026-10: Additional School-Based Services Changes
Wisconsin ForwardHealth·Effective Jul 1, 2026
ForwardHealth (Wisconsin Medicaid) now requires individual NPIs (Type 1) from prescribing/referring/ordering providers on certain school-based services claims, implements stricter time study requirements, and narrows specialized transportation coverage to only physically modified vehicles.
Low impact
ForwardHealth Update 2026-11: Compliance Guide for Wisconsin Correctional Facilities Serving Medicaid-Enrolled Youths Who Are Incarcerated
Wisconsin ForwardHealth·Effective Apr 1, 2026
Wisconsin correctional facilities must now comply with federal requirements to provide HealthCheck screenings and targeted case management services to Medicaid-enrolled incarcerated youths under 21 or former foster care youths under 26. Facilities can choose to enroll as Medicaid providers for reimbursement (starting April 1, 2026) or submit attestation forms if not enrolling.
Medium impact
ForwardHealth Update 2026-12: Prior Authorization Process Improvements: Revising the Prior Authorization/Chiropractic Attachment and Adding a Chiropractic Procedure Code
Wisconsin ForwardHealth·Effective Jan 1, 2026
ForwardHealth has revised the Prior Authorization/Chiropractic Attachment form with new checkboxes replacing text boxes, and added coverage for CPT code 98943 (extraspinal chiropractic manipulative treatment) effective January 1, 2026. The new PA form must be used immediately as submissions with the old form will be rejected.
Medium impact
ForwardHealth Update 2026-13: ForwardHealth Revises Adaptive Stroller Policy
Wisconsin ForwardHealth·Effective Jul 1, 2026
ForwardHealth is eliminating the all-inclusive E1035 code for adaptive strollers and requiring providers to use specific HCPCS codes with a UA modifier plus separate line items for accessories. This change aligns with national coding standards and affects prior authorization and billing processes.
Medium impact
ForwardHealth Update 2026-14: New Requirements and Policy Clarifications for Prenatal Care Coordination
Wisconsin ForwardHealth·Effective Jun 1, 2026
Wisconsin ForwardHealth has implemented significant changes to prenatal care coordination (PNCC) provider requirements including new staff qualifications, expanded background check requirements, updated forms, and restrictions on which provider types can offer PNCC services. Home visiting programs are now eligible while HMOs, private case management agencies, and individual nurses are no longer eligible.

Wisconsin ForwardHealth in WI Wisconsin ForwardHealth: Chiropractic Wisconsin ForwardHealth: Dentistry Wisconsin ForwardHealth: Endocrinology Wisconsin ForwardHealth: Family Medicine All payers

Get alerts for changes like this

Save a search and receive a daily digest whenever a new policy change matches your filters.

Create a free alert

ForwardHealth Update 2025-27: Prior Authorization Changes for Certain Preferred Drug List Classes, Anti-Obesity Drugs, and Other Pharmacy Policy Effective November 1, 2025

ForwardHealth Update 2025-28: ForwardHealth Reimbursement Rate Increases

ForwardHealth Update 2025-29: Severe Malocclusion Policy Clarification

ForwardHealth Update 2025-31: ForwardHealth Holiday Schedule

ForwardHealth Update 2025-32: 2025 Hospice Reimbursement Rate Changes

ForwardHealth Update 2025-33: ForwardHealth Enhances Behavioral Health Treatment With More Options for Continuing Care and Concurrent Services

ForwardHealth Update 2025-34: Prescribing, Referring, and Ordering Permissions UpdatedDecember 15, 2025: This Update has been revised since its original publication. Revised information appears in red text on page 1.

ForwardHealth Update 2025-35: Prior Authorization Process Improvements: Overview

ForwardHealth Update 2025-36: January 2026 Preferred Drug List Changes and Other Pharmacy PolicyJanuary 6, 2026: This Update has been revised since its original publication. Revised information appears in red text on pages 10, 29, and 33-34.

ForwardHealth Update 2025-37: Changes for Casgevy and Lyfgenia and Other Polices in the New Cell and Gene Therapy Access Model for Members With Sickle Cell Disease

ForwardHealth Update 2025-39: New Per Diem Crisis Stabilization Service Tiers and Billing Modifiers

ForwardHealth Update 2025-40: Expanding Tribal Federally Qualified Health Center Shared Savings

ForwardHealth Update 2025-41: Behavioral Treatment Benefit Policy Clarifications and ForwardHealth Online Handbook Revisions

ForwardHealth Update 2025-42: Reimbursement Increase for Nurse Aide Training and Testing

ForwardHealth Update 2026-01: ForwardHealth Expands Vaccine Billing Process Changes

ForwardHealth Update 2026-02: Tribal Federally Qualified Health Centers Can Bill Pharmacy Visits as Encounters

ForwardHealth Update 2026-03: Revised Billing for Tribal Federally Qualified Health Centers

ForwardHealth Update 2026-04: March 2026 Changes for Certain Preferred Drug List Classes and Other Pharmacy Policy

ForwardHealth Update 2026-05: New Coverage for Peer Recovery Support Services

ForwardHealth Update 2026-06: Tribal Federally Qualified Health Centers Can Receive All-Inclusive Rate Reimbursement for Compound Drug Claims

ForwardHealth Update 2026-07: CPT, HCPCS, and CDT Procedure Code Changes Effective January 1, 2026

ForwardHealth Update 2026-08: For Prenatal Care Coordination Providers: Milwaukee County Transition and Statewide Changes to Memoranda of Understanding Requirement

ForwardHealth Update 2026-10: Additional School-Based Services Changes

ForwardHealth Update 2026-11: Compliance Guide for Wisconsin Correctional Facilities Serving Medicaid-Enrolled Youths Who Are Incarcerated

ForwardHealth Update 2026-12: Prior Authorization Process Improvements: Revising the Prior Authorization/Chiropractic Attachment and Adding a Chiropractic Procedure Code

ForwardHealth Update 2026-13: ForwardHealth Revises Adaptive Stroller Policy

ForwardHealth Update 2026-14: New Requirements and Policy Clarifications for Prenatal Care Coordination