JavaScript is disabled or unavailable.Reimbursement PoliciesThese reimbursement policies apply to our Wisconsin Marketplace plans.Current Reimbursement Policies Navigate # A B C D E F G H I J K L M N O P Q R S T U V W X Y ZC Chiropractic Care CLIA-Waived Testing in Office Setting D Dental Services Rendered in a Hospital or Ambulatory Surgery Center Durable Medical Equipment (DME) Modifiers G General Health Laboratory Panel H Hemoglobin A1c I Intensive Outpatient Program-Behavioral Health Interest Payments M Modifier 25 Modifier 26 and TC Professional and Technical Component Modifier 59, XE, XP, XS, XU Modifiers N Neonatal Intensive Care Unit (NICU) Level of Care O Overpayment Recovery P Partial Hospitalization Program-Behavioral Health Pre-Exposure Prophylaxis Preventive Services Preventive Evaluation and Management Services and Acute Care Visit on Same Date of Service R Residential Treatment Services-Behavioral Health S Screening and Surveillance for Colorectal Cancer T Temporary Codes Transcutaneous Electrical Nerve Stimulators U Unlisted and Miscellaneous Codes V Vitamin D Testing Archived Reimbursement Policies