048-17 Wyo. Code R. § 17-4 - Payment Policy

Screening by the WCCEDP will be paid by the program at the Wyoming Medicaid allowable rates. For circumstances where multiple biopsy/removal techniques are used during one colonoscopy, the program will pay 100% for the allowable Medicaid reimbursement amount for the service of the highest cost, then 50% of the allowable Medicaid reimbursement amount for the second service and 25% of the allowable Medicaid reimbursement amount for the third and sequential techniques.

(a) The contractor must accept as payment in full the current Medicaid allowable charge in effect on the date of the covered service as identified on the WCCEDP CPT- code set.

(b) The Contractor is prohibited from making additional charge(s) to the client, any member of the client's family, or other sources of supplementation for those services covered by the WCCEDP.

(c) The Contractor shall have and/or retain the express right to bill clients enrolled in WCCEDP for any services not covered by the WCCEDP.

Notes

048-17 Wyo. Code R. § 17-4