048-17 Wyo. Code R. §§ 17-5 - Payment Policy

Screening by the WCCSP will be paid by the program at the current Wyoming Medicaid allowable rates for the date of service. For cirucumstances where multiple biopsy/removal techniques are used during one colonoscopy, the program will pay 100 percent for the allowable Medicaid reimbursement amount for the service of the highest cost, then 50 percent of the allowable Medicaid reimbursement amount for the second service, and 25 percent 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 WCCSP OPT code set.

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

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

Notes

048-17 Wyo. Code R. §§ 17-5