Updated Payment Policies - March 2025
Date: 01/31/25
MHS Health Wisconsin continually adds new or provides updates to clinical and payment policies to ensure they are designed to comply with industry standards while delivering the best experiences and outcomes for our members.
The following new policies or policy revisions are effective March 1, 2025.
You can view the details of these policies on their effective date by visiting Clinical and Payment Policies.
Policy Number | Policy Name | Line(s) of Business |
CP.MP.107 | DME | Medicaid; Medicare |
CP.MP.142 | Urinary Incontinence Devices and Treatments | Medicaid; Medicare |
CP.MP.180 | Implantable Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea | Medicaid; Medicare |
CP.MP.62 | Hyperhidrosis Treatments | Medicaid; Medicare |
V1.2025 | CG Testing: Aortopathies and Connective Tissue Disorders | Medicaid; Medicare |
V1.2025 | CG Testing: Cardiac Disorders | Medicaid; Medicare |
V1.2025 | CG Testing: Dermatologic Conditions | Medicaid; Medicare |
V1.2025 | CG Testing: Epilepsy, Neurodegenerative, and Neuromuscular Conditions | Medicaid; Medicare |
V1.2025 | CG Testing: Exome and Genome Sequencing for the Diagnosis of Genetic Disorders | Medicaid; Medicare |
V1.2025 | CG Testing: Eye Disorders | Medicaid; Medicare |
V1.2025 | CG Testing: General Approach to Genetic and Molecular Testing | Medicaid; Medicare |
V1.2025 | CG Testing: Hearing Loss | Medicaid; Medicare |
V1.2025 | CG Testing: Hematologic Conditions Non-Cancerous | Medicaid; Medicare |
V1.2025 | CG Testing: Hereditary Cancer Susceptibility | Medicaid; Medicare |
V1.2025 | CG Testing: Immune, Autoimmune, and Rheumatoid Disorders | Medicaid; Medicare |
V1.2025 | CG Testing: Kidney Disorders | Medicaid; Medicare |
V1.2025 | CG Testing: Lung Disorders | Medicaid; Medicare |
V1.2025 | CG Testing: Metabolic, Endocrine, and Mitochondrial Disorders | Medicaid; Medicare |
V1.2025 | CG Testing: Multisystem Inherited Disorders, Intellectual Disability, and Developmental Delay | Medicaid; Medicare |
V1.2025 | CG Testing: Prenatal Cell-Free DNA Testing | Medicaid; Medicare |
V1.2025 | CG Oncology: Algorithmic Testing | Medicaid; Medicare |
V1.2025 | CG Oncology: Cancer Screening | Medicaid; Medicare |
V1.2025 | CG Oncology: Circulating Tumor DNA and Circulating Tumor Cells (Liquid Biopsy) | Medicaid; Medicare |
V1.2025 | CG Oncology: Cytogenetic Testing | Medicaid; Medicare |
V1.2025 | CG Oncology: Molecular Analysis of Solid Tumors and Hematologic Malignancies | Medicaid; Medicare |
V1.2025 | CG Testing: Prenatal and Preconception Carrier Screening | Medicaid; Medicare |
V1.2025 | CG Testing: Prenatal Diagnosis (via Amniocentesis, CVS, or PUBS) and Pregnancy Loss | Medicaid; Medicare |
V1.2025 | CG Testing: Gastroenterologic Disorders Non-Cancerous | Medicaid; Medicare |
V1.2025 | CG Testing: Pharmacogenetics (Version A) | Medicaid; Medicare |
V1.2025 | CG Testing: Skeletal Dysplasia and Rare Bone Disorders | Medicaid; Medicare |
View all Clinical and Payment Policies.
Thank you for being a valued partner in caring for the health and well-being of our members. If you have any questions about the policies listed above or any our Clinical & Payment Policies, please contact your Provider Relations representative or call the Provider Inquiry Line at 1-800-222-9831. If you are unsure who is your representative, please email us at WI_Provider_Relations@mhswi.com.