048-17 Wyo. Code R. §§ 17-4 - Reimbursement for Services

Pursuant to W.S. § 35-25-204, the WCCSP will reimburse providers for the costs relating to colonoscopy screening. If a colonoscopy screening is unsuccessful and cannot be completed, an alternate screening method will be considered for reimbursement on a case-by-case basis as determined by the Department's staff physician.

(a) Services covered by the WCCSP. Reimbmrsement is paid for services listed on the program's CPT code list. The CPT-code list is located on the program's web site.

(b) Services not covered by the WCCSP.

(i) There will be no reimbursement to providers for colonoscopies or related costs performed prior to the WCCSP enrollment start date. The applicant/patient must have a WCCSP payment voucher to present to the provider prior to the procedure, unless otherwise approved by WCCSP. If applicant/patient does not have proper enrollment approval, the applicant/patient will assume responsibility for any costs relating to procedures performed prior to enrollment approval,

(ii) Reimbursement for adverse events is not covered by the WCCSP.

(iii) The WCCSP shall not reimburse for follow-up surgery or additional care needed if an actual cancer or other condition requiring additional medical care is found.

Notes

048-17 Wyo. Code R. §§ 17-4