Electronic Visit Verification (EVV): Service Codes that Require Use of an EVV System in Wisconsin

EVV is federally required for Medicaid-covered personal care, applicable supportive home care, and home health care services. This includes services authorized through Medicaid and BadgerCare Plus fee-for-service, health maintenance organizations (HMOs), long-term care managed care organizations (MCOs), and IRIS (Include, Respect, I Self-Direct). EVV visit data will need to be collected for care provided under the following service codes:

Personal care and supportive home care service codes that require EVV in Wisconsin

Service	Medicaid and BadgerCare Plus Fee-For-Service and BadgerCare Plus and Medicaid Supplemental Security Income (SSI) HMOs	Family Care and Family Care Partnership	IRIS	Live-in Worker Required by DHS to Capture EVV Information*	Status: Soft Launch (on Jan. 1, 2024) or Hard Launch
T1019: Personal care services; per 15 minutes	Yes	Yes	Yes	No*	Hard Launch
T1020: Personal care services; per day	N/A	Yes	No	No*	Hard Launch
S5125: Supportive home care; per 15 minutes	N/A	Yes	Yes	No*	Hard Launch
S5126: Supportive home care; per day	N/A	Yes	Yes	No*	Hard Launch
99509: Nurse supervisory visit; Home visit for assistance with activities of daily living and personal care; per visit	Yes	Yes	No	Yes	Soft Launch

Home health care service codes that require EVV in Wisconsin

Service	Medicaid and BadgerCare Plus Fee-For-Service and BadgerCare Plus and Medicaid SSI HMOs	Family Care and Family Care Partnership	IRIS	Live-in Worker Required by DHS to Capture EVV Information*	Status: Soft Launch (on Jan. 1, 2024) or Hard Launch
92507: Treatment of speech, language, voice, communication, and/or auditory processing disorder; per visit	Yes	Yes	No	Yes	Soft Launch
97139: Unlisted therapeutic procedure – Occupational therapy; per visit	Yes	Yes	No	Yes	Soft Launch
97799: Unlisted physical medicine/rehabilitation service or procedure – Physical therapy; per visit	Yes	Yes	No	Yes	Soft Launch
99504: Home visit for mechanical ventilation care; per hour	Yes	Yes	No	Yes	Soft Launch
99600: Unlisted home visit service or procedure; per visit	Yes	Yes	No	Yes	Soft Launch
S9123: Non-vent private duty nursing care in the home – by registered nurse; per hour	Yes	Yes	No	Yes	Soft Launch
S9124: Non-vent private duty nursing care in the home – by licensed practical nurse; per hour	Yes	Yes	No	Yes	Soft Launch
T1001: Nursing assessment/evaluation; per visit	Yes	Yes	No	Yes	Soft Launch
T1021: Home health aide or certified nurse assistant; per visit	Yes	Yes	No	Yes	Soft Launch
T1502: Administration of oral, intramuscular and/or subcutaneous medication by health care agency/ professional; per visit	Yes	Yes	No	Yes	Soft Launch

*MCOs, HMOs, and provider agencies may independently require live-in workers to use EVV. Fiscal employer agencies for the IRIS program may not require participant-hired live-in workers to use EVV.

The Wisconsin Department of Health Services created two phases for EVV: soft launch and hard launch

The first phase is called soft launch. During soft launch, EVV is required, but there are no financial consequences if EVV information is missing. Providers (including independent nurses) and workers should use the soft launch phase to review training, practice using their EVV system, and troubleshoot problems.
The second phase is called hard launch. Hard launch is when payers will begin imposing consequences when claims are missing required EVV information. Consequences for providers include claim denial, possible provider enrollment sanctions, and possible IRIS participant disenrollment. Consequences for HMOs and MCOs are exclusion of non-compliant claims from future capitation rate-setting development. Hard launch is required by the federal government for Wisconsin to continue receiving its full federal funding.

EVV timeline

Hard launch for personal care and supportive home care services began on May 1, 2023.
Soft launch for home health care services and personal care nurse supervisory code 99509 will start on January 1, 2024. DHS will give stakeholders at least three months’ notice before moving from soft launch to hard launch later in 2024.