| 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 | Z | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1 | PA Required | Service | UW/UPM | |||||||||||||||||||||||
2 | Last updated: 1/6/26 | |||||||||||||||||||||||||
3 | Laboratory Services | |||||||||||||||||||||||||
4 | *** Members encouraged to use assigned primary care clinic, however, any delivery system within Dane County is allowed as long as member has | |||||||||||||||||||||||||
5 | an order via fax or paper in hand, includes GHC labs. | |||||||||||||||||||||||||
6 | Routine Labs | Any UW or UPM location or GHC clinics (order needs to be faxed or paper order given to patient) | ||||||||||||||||||||||||
7 | Stat or Pre-Treatment Labs or Clinic Collected Specimens at Specialty office visit 1 | Any UW or UPM location | ||||||||||||||||||||||||
8 | Pharmacy | |||||||||||||||||||||||||
9 | All Pharmacy (ER, specialist order, hospital) | GHC Staff model pharmacies, Navitus Network Pharmacies | ||||||||||||||||||||||||
10 | Urgent & Emergency Services | |||||||||||||||||||||||||
11 | If life or limb theatening emergency-member should proceed to the closest available emergency room. | |||||||||||||||||||||||||
12 | Urgent Care 2 | GHC Urgent Care Clinic at Captial Clinic (608 257-9700) will schedule same day appt. We prefer members to use our GHC urgent care whenever possible however, we encourage members to use another contracted UC for services unless they're out of the service area then use the nearest UC. | ||||||||||||||||||||||||
13 | Hospital Emergency Room | UW (preferred), UPM, UW Stoughton members can use Stoughton Hospital | ||||||||||||||||||||||||
14 | OB Related Emergency | UPM Hospital | ||||||||||||||||||||||||
15 | Radiology & Other Procedures | |||||||||||||||||||||||||
16 | Arterial Blood Gas | UW, UPM | ||||||||||||||||||||||||
17 | Ankle Brachial Index (ABI) | UW, UPM | ||||||||||||||||||||||||
18 | Biopsy | UW, UPM (PA) (breast biopsy at GHC), UW Stoughton member can use UW Stoughton Clinic | ||||||||||||||||||||||||
19 | Bone Mineral Density (DEXA) | GHC HH Clinic (21 yrs or older), UW-Only if unavailable at GHC (PA) | ||||||||||||||||||||||||
20 | Brochoscopy | UW, UPM | ||||||||||||||||||||||||
21 | Capsule Endoscopy/Enteroscopy | UW, UPM | ||||||||||||||||||||||||
22 | Colonoscopy | UWHC-Digestive Health Center, UPM (UW Physician) | ||||||||||||||||||||||||
23 | CT (Computed Tomography) All routine scans (Abdomen, Chest, Head, MAKO Surgical Planning, Low Dose Screenings, Pelvis, Spine, Upper/Lower Extremity, CT Angio PE protocol) | GHC HH | ||||||||||||||||||||||||
24 | PA | CT Scans Not Performed at GHC 25 | UW, UPM | |||||||||||||||||||||||
25 | Doppler/Duplex or Vascular (Venous) Imaging | GHC-HH (Lower & Upper-2/14/22: Carotid/Duplex, Venous Bilateral/Duplex Extermity and Venous Unilateral/Duplex), {UW/UPM any not available at GHC} | ||||||||||||||||||||||||
26 | Echocardiogram/Doppler (Heart) | UW, UPM | ||||||||||||||||||||||||
27 | PA | EEG | UW (Neurotech does the monitoring and is INN, you won't find them in Provider Hub) | |||||||||||||||||||||||
28 | EKG/ECG | PCP location-Preferred, UW | ||||||||||||||||||||||||
29 | EMG/Nerve Conduction Study | UW | ||||||||||||||||||||||||
30 | Fine Needle Aspiration (FNA) 3 | UW | ||||||||||||||||||||||||
31 | Flex Sigmoidoscopy | UW, UPM | ||||||||||||||||||||||||
32 | Hepatobiliary Imaging (HIDA) | UW, UPM | ||||||||||||||||||||||||
33 | Holter Monitor | UW, UPM | ||||||||||||||||||||||||
34 | PA | Hysterosalpingograms (HSG) 20 (infertility related?) | UW, UPM | |||||||||||||||||||||||
35 | Mammogram: Digital, Screening, Diagnostic, w/Tomosynthesis (3D) | GHC HH (expected-fax# 608 661-7205), if unavailable at GHC-UW (PA) or UPM (PA) | ||||||||||||||||||||||||
36 | PA | MRI/MRA (Angio) | UW (Preferred), UPM | |||||||||||||||||||||||
37 | PA | MRI (Open) 12 | UW (1 S. Park St)-Wide Bore | |||||||||||||||||||||||
38 | PA | MR Arthrogram | UW | |||||||||||||||||||||||
39 | PA | MRCP | UW | |||||||||||||||||||||||
40 | PA | Myocardial Perfusion/SPECT (Nuclear Medicine Stress Test) | UW, UPM | |||||||||||||||||||||||
41 | PA | Nuclear Medicine Bone Scans | UW, UPM | |||||||||||||||||||||||
42 | PA | PET/Whole Body Scans | UW, UPM | |||||||||||||||||||||||
43 | PH Impedance | UW, UPM | ||||||||||||||||||||||||
44 | Plain Films/X-rays 15 | UW clinics, UPM clinics, GHC clinics (w/orders, no longer perform lung cancer screenings) | ||||||||||||||||||||||||
45 | Pulmonary Function Testing | UW, UPM | ||||||||||||||||||||||||
46 | PA | Sonohysterograms 20 (infertility related?) | UW, UPM | |||||||||||||||||||||||
47 | Stress Testing (Exercise) | UW | ||||||||||||||||||||||||
48 | Thyroid Uptake & Scan (NM) | UW, UPM | ||||||||||||||||||||||||
49 | Ultrasound (Routine & Obstetrical) 23 | GHC HH, UW Generations (7 week Ultrasound for Fertility Patients) | ||||||||||||||||||||||||
50 | PA | Ultrasounds (Obstetrical-High Risk) | UPM Center for Perinatal Care 24 (PA required as of 10/1/22) | |||||||||||||||||||||||
51 | PA | Ultrasounds (Targeted) | UPM Center for Perinatal Care 24 (PA required as of 10/1/22) | |||||||||||||||||||||||
52 | PA | Ultrasounds NOT performed at GHC 23 | UW, UPM (PA required as of 10/1/22) | |||||||||||||||||||||||
53 | Upper GI Endoscopy (EGD) | UW, UPM | ||||||||||||||||||||||||
54 | Specialty Consults and Other Services | |||||||||||||||||||||||||
55 | PA | Abortions (Therapeutic) | UPM-if meets criteria | |||||||||||||||||||||||
56 | Allergy Consult 17 | UW | ||||||||||||||||||||||||
57 | Ambulance-Only Emergency Services | Emergency only | ||||||||||||||||||||||||
58 | Ambulance-Non-Emergent Transport | Edgerton Fire Protection District (608) 332-9462 (cell) (effective 11/1/22-Care Management will coordinate) | ||||||||||||||||||||||||
59 | PA | Ambulatory EEG | Neurotech LLC | |||||||||||||||||||||||
60 | Audiology Consult 16 | UW (if member to receive hearing aids and needs hearing test to get hearing aid, send to Beltone for both) | ||||||||||||||||||||||||
61 | PA | Autism Diagnostic Evaluation | Athena Lickel (fax order, clinical notes to: 608 441-3291) | |||||||||||||||||||||||
62 | PA | Autism Treatment (ABA-applied behaviour analysis) | GHC, Achieving Collaborative Treatment, Caravel Autism Health, Family Path Autism Services, UW Waisman Center Autism Treatment Programs, Ignite Child Development Services, Mindcolor Autism, WI Early Autism Project, Bridges Consultation and Treatment (4/1/23) | |||||||||||||||||||||||
63 | PA | Autism Treatment (OT/ST) | CI Pediatric Therapy Centers (formerly Communication Innovations), UW Health Rehab/Middleton Rehab, Meriter, Aspire Wisconsin | |||||||||||||||||||||||
64 | PA | Bariatric Surgery/Medical-Surgical Weight Management Programs 21 | UW | |||||||||||||||||||||||
65 | Behavioral Health/Outpatient Psychiatry 27 | Any contracted provider in Dane County or Regional Network as of 7/15/21 | ||||||||||||||||||||||||
66 | Breast Clinic Consult 4 | UW | ||||||||||||||||||||||||
67 | Breast Pumps | UW Health Care Direct, Unity Point at Home (hospital grade) | ||||||||||||||||||||||||
68 | PA | Cardiac Rehabilitation | UW, UPM | |||||||||||||||||||||||
69 | Cardiology Consult (including Electrophysiology, Faint & Fall Clinic and Preventive Cardiology) | UW, Atrium, Arbor Gate Heart Clinic-Faint & Fall Clinic (Unity Point) 9 | ||||||||||||||||||||||||
70 | Cardiothoracic Surgery | UW | ||||||||||||||||||||||||
71 | Chiropractic | GHCSCW (Capital, East, HH, Sauk Trails) | ||||||||||||||||||||||||
72 | Complimentary Medicine 14 | No longer available as of 1/1/24 (see footnote) | ||||||||||||||||||||||||
73 | Dermatology Consult | GHC-HH (an order from their PCP is required-fax# (608) 204-9626), (UW-UPM) (PA) | ||||||||||||||||||||||||
74 | PA | Dialysis | Fresenius Kidney Care (includes Madison Area Renal Specialists within Fresenius), Tri-State Dialysis (563) 589-3915 (eff 6/1/24-term 10/31/25) | |||||||||||||||||||||||
75 | PA | Durable Medical Equipment | See Durable Medical Equipment tab | |||||||||||||||||||||||
76 | Endocrinology-including Osteoporosis Clinic | UW | ||||||||||||||||||||||||
77 | Endodontics | Madison Endodontics | ||||||||||||||||||||||||
78 | ENT-aka Otolaryngology | UW | ||||||||||||||||||||||||
79 | Gastroenterology & Hepatology (GI) | UW | ||||||||||||||||||||||||
80 | Genetic Counseling | GHC HH, (UW & UPM if referred by GHC Genetics-Referral/PA) | ||||||||||||||||||||||||
81 | PA | Genetic Testing | GHCSCW Labs 11, (UW Stoughton clinic-if referred by GHC Genetics) | |||||||||||||||||||||||
82 | Geriatrics (Falls & Mobility Clinic) | UW | ||||||||||||||||||||||||
83 | Gynecology & Obstetrics | UW, UPM | ||||||||||||||||||||||||
84 | Headache Clinic | UW | ||||||||||||||||||||||||
85 | Health Education 3 (Asthma, Diabetes & Nutrition/Dietician (all ages) | GHC 3, UWHC 3, UPM 3; (12/11/23-Due to access issues, members can see Dieticians at UW, Synergos & Edelweiss without a PA or order and this does not have to be in tandem with seeing a BH provider), (Badgercare needs to use UW for all of these) | ||||||||||||||||||||||||
86 | PA | Hearing Aids | Serig's Beltone (preferred), UW 16, Non-Contracted vendor 16 | |||||||||||||||||||||||
87 | Hematology | UW | ||||||||||||||||||||||||
88 | PA | Home Health | UW Health Care Direct, Interim Healthcare, Aveanna Health, Commonheart Home Health-eff 2/1/23 (844) 206-4930 | |||||||||||||||||||||||
89 | PA | Home IV Infusion Therapy | UW Health Care Direct | |||||||||||||||||||||||
90 | PA | Hospice | Agrace Hospice & Palliative Care (Preferred-INPT), Heartland Hospice (term 4/29/25), Rainbow Hospice, 1225 Remmel Dr, Johnson Creek WI, 53094, (920) 674-6255, Commonheart Home Health-eff 2/1/23 (844) 206-4930 | |||||||||||||||||||||||
91 | PA | Hyperbaric Oxygen | Wisconsin Hyperbaric Oxygen, 4660 S Biltmore Ln, Madison WI, 53718: P# (608) 284-8654, F# (855) 374-5850 | |||||||||||||||||||||||
92 | Infectious Disease | UW | ||||||||||||||||||||||||
93 | Infertility Service 20 | Generation Fertility Care (UW), Wisconsin Fertility | ||||||||||||||||||||||||
94 | PA | Infusion Clinic 26 | UW, UPMm Smart Medical (Medicare/Medicare Select only) | |||||||||||||||||||||||
95 | PA | Intensive Outpatient (behavioral health) 27 | GHC Foundations (preferred), Miramont Behavioral Health, 3169 Deming Way, Middleton WI, 53562, (608) 716-8288 (terming 3/31/25), Edelweiss, Iris Health Clinic LLC, 255 W Broadway, Waukesha WI, 53186, (262) 420-9088 (eff 6/1/24) | |||||||||||||||||||||||
96 | PA | Intensive Outpatient (substance use disorder) 18 | UW Behavior Health & Recovery 8 (no PA), UPM Newstart, Aurora Psychiatric Hospital Dewey Center (414) 454-6600, Iris Health Clinic LLC, 255 W Broadway, Waukesha WI, 53186, (262) 420-9088 (eff 6/1/24), Sals Recovery Center DBA WisHope Recovery, 223 Wisconsin Ave, Ste A, Waukesha WI, 53186, (262) 701-7257 (includes Brookfield and Brodhead) (eff 6/1/24) | |||||||||||||||||||||||
97 | Lactation Counseling | GHC, UW, UPM (breastfeeding warmline), Sweet Latch & Wellness (PA-not Badgercare certified) | ||||||||||||||||||||||||
98 | PA | Light Therapy, Ultraviolet | GHC-HH (does UV-B only, no PA required), UW (if services cannot be provided at GHC and PA obtained) | |||||||||||||||||||||||
99 | Methadone Clinics 28 | Addiction Services & Pharmacotherapy-Methadone, Madison East & West Comprehensive Treatment Centers-Methadone, Psychological Addiction Services-Methedone, Tellurian-Suboxone (PA) | ||||||||||||||||||||||||
100 | PA | Mohs Surgery (Dematology) | UW |