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Fee Schedules

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Table of Contents
NCCI
Diagnosis Lists
Standard Fee Schedule
Dental Fee Schedule
Genetic Testing Fee Schedule
APR DRG Pricing
OPPS Information

 

NCCI

The Medicaid fee schedule should be used in conjunction with the CMS NCCI tables. The NCCI tables contain the most current information regarding CPT & HCPCS coding (procedure to procedure editing and maximum units). The Patient Protection and Affordable Care Act require State Medicaid programs to incorporate "NCCI methodologies" in their claims processing systems.

Diagnosis Lists

Some codes require specific diagnosis codes.  Review the appropriate list for the approved diagnosis codes.  Also included is the list of invalid diagnosis codes.

Diagnosis Lists
PASRR Level 2 Diagnosis List
Diagnosis List for Blood Glucose Testing
Diagnosis List G9012
Diagnosis List H2014, H2017, H2019
Diagnosis List for OB Ultrasound and Fetal-Nonstress Tests
Diagnosis List for Applied Behavior Analysis
Invalid Diagnosis Listing



Standard Fee Schedule Updated Nightly

Wyoming Medicaid has replaced the old fee schedule spreadsheets with a new easy-to-use Procedure Code Search.  It provides the same information, but includes the following new features:

  • Search for a procedure code by key word(s) in the description
  • Lookup revenue codes as well as procedure codes
  • Nightly updates from Wyoming Medicaid claims payment system
  • Descriptions added to frequently used indicators (Code Type, Fee Schedule, Factor Code)
 Procedure Code Search Page
OR
Download the Fee Schedule File
* CSV files can be opened using Microsoft Excel or other spreadsheet programs

The Fee Schedule that is available for download is updated Monday through Friday at 6AM.

Dental Fee Schedule

Wyoming Medicaid Dental  providers should refer to the Dental Fee Schedule when researching codes. This fee schedule offers a list of codes, the reimbursement rate, any age limitations, and a column specfic to whether the code requires an LOA for reimbursement.

Wyoming Medicaid 2020 Dental Fee Schedule

Wyoming Medicaid 2021 Dental Fee Schedule

Genetic Testing

All genetic testing services require a Prior Authorization and will be manually priced.

Genetic Testing Fee Schedule
 

APR DRG Pricing

Inpatient hospital claims are paid via the All Patient Refined Diagnosis-Related Grouping Methodology.  Wyoming Medicaid uses 3Ms APR DRG Grouping and Pricing software to classify cases and to determine a prospective rate. The below link provides an excel spreadsheet to assist estimating reimbursement via DRG.

Wyoming DRG Calculator 2021

Wyoming DRG Calculator 2020

 
APC Fee Schedules

OPPS Information 

 
Hospital Outpatient PPS - Resources related to Medicare OPPS information which may assist in understanding Wyoming Medicaid OPPS priced claims.

Hospital Outpatient PPS Transmittals - Quarterly updates to OCE software for OPPS modifications. By searching on quarterly transmittals, Appendix M Summary of Modifications resources can be found for: diagnosis coding changes, status indicator changes, HCPC changes, and composite APCs.  ***Please note that the transmittal is not always a direct crosswalk to Wyoming Medicaid; it is a reflection of CMS Manual changes and Wyoming might choose to modifiy certain aspects. 

NCCI Edits - Hospital PPS - This page will allow review of mutually exclusive and incompatible code combinations

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APC-Based Fee Schedule Effective Date Wyoming Medicaid Implementation  Date
APC-Based Fee Schedule 1.1.21  Excel Ver 1/1/21 4/1/21
APC-Based Fee Schedule 10.1.20 Excel Ver 10/1/20 1/1/21
APC-Based Fee Schedule 7.1.20 Excel Ver 7/1/20 10/1/20
APC-Based Fee Schedule 4.1.20 (Excel ver) 4/1/20 7/1/20
APC-Based Fee Schedule 1.1.20(Excel ver) 1/1/20 4/1/20
APC-Based Fee Schedule 10.1.19 (Excel ver) 10/1/19 1/1/20
APC-Based Fee Schedule 7.1.19 (Excel ver) 7/1/19 10/1/19
APC-Based Fee Schedule 4/1/19 (Excel ver) 4/1/19 7/1/19
APC-Based Fee Schedule 1/1/19 (Excerl ver) 1/1/19 4/1/19
APC-Based Fee Schedule 10/1/18 (Excel ver) 10/1/18 1/1/19
APC-Based Fee Schedule 7/1/18 (Excel ver) 7/1/18 10/1/18
APC-Based Fee Schedule 4/1/2018 (Excel ver) 4/1/18 7/1/18
APC-Based Fee Schedule 1/1/2018 (Excel ver) 1/1/18 4/1/18
APC-Based Fee Schedule 10/1/2017  (Excel ver)    
APC-Based Fee schedule 7/01/17 (Excel ver)    
APC-Based Fee Schedule 4/01/17 (Excel ver)    
APC-Based Fee Schedule 1/01/17 - Updated (Excel ver)    
APC-Based Fee Schedule 11/01/16 -Updated (Excel ver) 11/01/2016 - 3/31/2017 1/1/2017 - 3/31/2017
APC-Based Fee Schedule 11/01/2016 (Excel ver) 11/01/2016 - 12/31/2016 11/01/2016 - 12/31/2016
APC-Based Fee Schedule 10/01/16 - Updated 10/1/2016 - 10/31/2016 1/1/2017 - 3/31/2017
APC-Based Fee Schedule 10/01/2016 (Excel ver) 07/01/2016 - 10/31/2016 10/01/2016 - 12/31/2016
APC-Based Fee Schedule 7/1/2016 Updated (Excel ver) Updated 9/29/16
APC-Based Fee Schedule 4/1/2016 (Excel Ver)
APC-Based Fee Schedule 1/4/2016 (Excel ver)    
APC-Based Fee Schedule 7/1/2015 (Excel ver)    
APC-Bases Fee Schedule 4/1/2015 (Excel ver)    
APC-Based Fee Schedule 1/1/2015 (Excel ver)    
APC-Based Fee Schedule 10/1/2014 (Excel ver)    
APC-Based Fee Schedule 7/1/2014 (Excel ver)    
 APC-Based Fee Schedule 4/1/2014 (Excel Ver)

 

  
 APC-Based Fee Schedule 1/1/2014 (Excel Ver)    
 APC-Based Fee Schedule 10/1/2013 (Excel Ver)    
 APC-Based Fee Schedule 7/1/2013 (Excel Ver)    
 APC-Based Fee Schedule 4/1/2013 (Excel Ver)    
 APC-Based Fee Schedule 1/1/2013 (Excel Ver)  
APC-Based Fee Schedule 10/1/2012 (Excel Ver)    
APC-Based Fee Schedule 7/1/2012 (Excel Ver)    
APC-Based Fee Schedule 4/1/2012 (Excel Ver)    
APC-Based Fee Schedule 1/1/2012 (Excel Ver)    
APC-Based Fee Schedule 10/1/2011 (Excel Ver)    
APC-Based Fee Schedule 7/1/2011 (Excel Ver)    
APC-Based Fee Schedule 4/1/2011 (Excel Ver)    
APC-Based Fee Schedule 12/31/2010 (Excel Ver)
APC-Based Fee Schedule 10/1/2010 (Excel Ver)
APC-Based Fee Schedule 7/1/2010 (Excel Ver)    
APC-Based Fee Schedule 1/1/2010 (Excel Ver)

 

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