Wyoming Administrative Code
Agency 048 - Health, Department of
Sub-Agency 0037 - Medicaid
Chapter 6 - HEALTH CHECK (FORMERLY EPSDT) PROGRAM
Section 6-10 - Medicaid allowable payment
Universal Citation: WY Code of Rules 6-10
Current through September 21, 2024
(a) The Medicaid allowable payment for HEALTH CHECK services is the lower of the providers usual and customary charge and the Medicaid fee schedule. Laboratory tests and immunizations are separatey reimbursed at the lower of the provider's usual and customary charge and Medicaid fee schedule.
(b) Treatment and referral services. The Medicaid allowable payment for the referral and treatment of conditions detected during a HEALTH CHECK examination shall be determined pursuant to the rules of the Department.
(c) Expanded services. Expanded services are reimbursed:
(i) Pursuant to the other rules of the
Department, if the expanded service is a covered services under any such rule;
or
(ii) At the lower of the
provider's usual and customary charge and the Medicaid fee schedule, if the
expanded service is not a covered service under any of the Departments
rules.
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