Schedule C WI Prod & Ben Usage.xlsx

This is a Schedule C document detailing FY2020 Wisconsin average product and beneficiary usage data for Medicaid-covered incontinence and ostomy supplies from October 1, 2019 through September 30, 2020. The schedule provides comprehensive utilization metrics for 49 distinct HCPCS codes and product categories, including belted and unbelted undergarments, continence supplies, and related medical devices. The data encompasses monthly average beneficiary counts, total billed units, and monthly average billed units across the Wisconsin Medicaid program. Notable high-utilization items include T4541 with 4,051 monthly average beneficiaries and 323,067 monthly average billed units; T4535 with 2,556 monthly average beneficiaries and 376,098 monthly average billed units; and T4526 with 1,210 monthly average beneficiaries and 124,897 monthly average billed units. Several codes are noted as not covered, covered outside the contract, or requiring prior authorization.

The document reflects Wisconsin's established reimbursement policies, including provisions that A4351 and A4352 are reimbursed without modifiers across the beneficiary lifespan, and A4402 is covered outside the contract scope. Item A6250 is identified as a new coverage addition with this contract, marked as an estimate since Wisconsin had no prior utilization data. The schedule demonstrates substantial Medicaid demand for continence and ostomy products statewide, with combined beneficiary populations and billed units indicating significant program expenditures and beneficiary reliance on covered supplies during the fiscal year.