Wisconsin Patient Health Care Records Access Fees vs. HIPAA: Key Differences Explained

Wisconsin Medical Records Fee Structure

Wisconsin caps what health care providers may charge for copies of patient health care records under Wis. Stat. § 146.83(3f). The Department of Health Services (DHS) applies a Consumer Price Index adjustment every July 1. For July 1, 2026–June 30, 2027, DHS set: paper copies at $1.48/page (first 25), $1.10/page (26–50), $0.72/page (51–100), and $0.42/page (101+); microfiche or microfilm at $2.17/page; and prints of X‑rays at $14.56 each. Shipping and applicable taxes may be added. The CPI difference used for this cycle is 2.70%. ([dhs.wisconsin.gov](https://www.dhs.wisconsin.gov/health-care-coverage/records-fees.htm))

Retrieval fee regulations and the fee certification charge apply only when the requester is not the patient or a person authorized by the patient: a single $29.20 retrieval fee and an $11.68 certification charge may be added, plus shipping and taxes. ([dhs.wisconsin.gov](https://www.dhs.wisconsin.gov/health-care-coverage/records-fees.htm))

How the state caps work in practice

• State fee caps are format‑specific: paper, microfiche/microfilm, and X‑ray prints. There is no state‑listed per‑page rate for electronic copies (see Electronic Medical Records Fee Policies below). ([wicourts.gov](https://www.wicourts.gov/sc/opinion/DisplayDocument.pdf?content=pdf&seqNo=641018))
• Caps are updated annually via Consumer Price Index adjustment; always check the current July 1–June 30 DHS schedule before invoicing. ([dhs.wisconsin.gov](https://www.dhs.wisconsin.gov/health-care-coverage/records-fees.htm))

HIPAA Reasonable Cost-Based Fees

Under the HIPAA Privacy Rule, when an individual (or personal representative) requests access, you may charge only a reasonable cost-based fee. That fee may include: labor for copying (paper or electronic), supplies (e.g., paper, toner, CD/USB if requested), postage, and a summary/explanation if the individual agrees in advance. Search, retrieval, verification, and other non-copying overhead are not allowed. ([govinfo.gov](https://www.govinfo.gov/content/pkg/CFR-2025-title45-vol2/pdf/CFR-2025-title45-vol2-part164.pdf))

HIPAA’s fee limits apply to covered entities. OCR has explained it cannot directly enforce the “reasonable, cost‑based fee” limit against business associates; however, covered entities remain responsible for ensuring any business associate charges comply with HIPAA’s access‑fee rules. ([hhs.gov](https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/business-associates/factsheet/index.html))

When state law is more protective (for example, by prohibiting certain fees), providers must follow both HIPAA and state law; in Wisconsin, that means honoring state prohibitions on electronic medical records fees even though HIPAA would otherwise allow a reasonable cost‑based fee. ([wicourts.gov](https://www.wicourts.gov/sc/opinion/DisplayDocument.pdf?content=pdf&seqNo=641018))

Medicaid and BadgerCare Plus Reduced Fees

Wisconsin Medicaid and BadgerCare Plus impose additional Wisconsin Medicaid fee limitations. If the member is enrolled on the date of the request, providers are limited to charging 25% of the applicable state‑capped fees for one set of copies of the member’s records; additional sets may be charged at 100% of the applicable caps. This reduction applies regardless of dates of service contained in the records. ([forwardhealth.wi.gov](https://www.forwardhealth.wi.gov/WIPortal/Subsystem/KW/Print.aspx?c=3&ia=1&nt=Member+Access+to+Records&p=1&s=1&sa=8))

Because state law does not permit providers to charge for electronic copies, the 25% reduction effectively results in a $0 charge for electronic copies provided to enrolled members. Paper, microfiche, and X‑ray print charges follow the 25% rule for one set. ([wicourts.gov](https://www.wicourts.gov/sc/opinion/DisplayDocument.pdf?content=pdf&seqNo=641018))

Electronic Medical Records Fee Policies

Electronic medical records fees are treated differently in Wisconsin. The Wisconsin Supreme Court held that because § 146.83(3f) lists fees only for paper, microfiche/microfilm, and X‑ray prints, a provider may not charge any fee for providing electronic copies. In short: no provider fees for electronic copies of patient health care records under Wisconsin law. ([wicourts.gov](https://www.wicourts.gov/sc/opinion/DisplayDocument.pdf?content=pdf&seqNo=641018))

HIPAA still permits a reasonable cost‑based fee for an individual’s access in general, but Wisconsin’s prohibition controls for provider charges in electronic format. If you use a business associate to fulfill requests, you remain responsible under HIPAA for ensuring the individual is not charged impermissible amounts. ([govinfo.gov](https://www.govinfo.gov/content/pkg/CFR-2025-title45-vol2/pdf/CFR-2025-title45-vol2-part164.pdf))

Fee Calculation Methods

For Wisconsin-capped formats (paper, microfiche/microfilm, X‑ray prints)

• Paper: multiply pages in each tier by the 2026–2027 per‑page rates; sum tiers. Add actual shipping and applicable taxes. If the requester is not the patient or a person authorized by the patient, add one $11.68 fee certification charge and one $29.20 retrieval fee. ([dhs.wisconsin.gov](https://www.dhs.wisconsin.gov/health-care-coverage/records-fees.htm))
• Microfiche/microfilm: per‑page at $2.17; add shipping/taxes; apply certification/retrieval charges only if the requester is neither the patient nor a person authorized by the patient. ([dhs.wisconsin.gov](https://www.dhs.wisconsin.gov/health-care-coverage/records-fees.htm))
• X‑ray prints: $14.56 per image; add shipping/taxes; certification/retrieval as applicable. ([dhs.wisconsin.gov](https://www.dhs.wisconsin.gov/health-care-coverage/records-fees.htm))
• Medicaid/BadgerCare: for one set to an enrolled member, multiply the above “applicable fees” by 25%; additional sets may be billed at 100%. ([forwardhealth.wi.gov](https://www.forwardhealth.wi.gov/WIPortal/Subsystem/KW/Print.aspx?c=3&ia=1&nt=Member+Access+to+Records&p=1&s=1&sa=8))

For HIPAA access requests

• Charge only a reasonable cost‑based fee limited to copying labor, supplies, postage, and any requested summary. Exclude search, retrieval, verification, and other overhead. Document how you calculated the fee. ([govinfo.gov](https://www.govinfo.gov/content/pkg/CFR-2025-title45-vol2/pdf/CFR-2025-title45-vol2-part164.pdf))
• In Wisconsin, do not charge provider fees for electronic copies, even though HIPAA would otherwise allow a cost‑based fee. ([wicourts.gov](https://www.wicourts.gov/sc/opinion/DisplayDocument.pdf?content=pdf&seqNo=641018))

Authorized Requester Fee Variations

Wisconsin law distinguishes between the patient or a person authorized by the patient and everyone else. Patients and authorized patient representatives (for example, an attorney with a valid HIPAA authorization) are exempt from the certification and retrieval charges. Third parties who are not authorized by the patient may be charged those additional fees within the DHS‑adjusted limits. ([wicourts.gov](https://www.wicourts.gov/sc/opinions/14/pdf/14-2236.pdf?utm_source=openai))

Under HIPAA, an individual’s personal representative stands in the individual’s shoes for right‑of‑access purposes, so the reasonable cost‑based fee limits apply to that representative as well. Providers remain responsible for any amounts their business associates bill to the individual for access. ([govinfo.gov](https://www.govinfo.gov/content/pkg/CFR-2025-title45-vol2/pdf/CFR-2025-title45-vol2-part164.pdf))

Legal Precedents on Electronic Records Fees

Banuelos v. University of Wisconsin Hospitals and Clinics Authority (2023 WI 25)

The Wisconsin Supreme Court held that § 146.83(3f) “does not permit charges for copies of electronic records” because the statute enumerates only paper, microfiche/microfilm, and X‑ray formats. As a result, providers may not impose electronic records fees under Wisconsin law. ([wicourts.gov](https://www.wicourts.gov/sc/opinion/DisplayDocument.pdf?content=pdf&seqNo=641018))

Moya v. Aurora Healthcare, Inc. (2017 WI 45)

The Court held that an attorney with a written HIPAA authorization is a “person authorized by the patient,” and thus exempt from certification and retrieval fees. This decision defines how the exemption applies to authorized requesters. ([wicourts.gov](https://www.wicourts.gov/sc/opinions/14/pdf/14-2236.pdf?utm_source=openai))

Townsend v. ChartSwap, LLC (2021 WI 86)

The Court clarified that the statutory fee caps regulate “health care providers,” not third‑party record vendors. However, providers remain responsible for ensuring compliance with both Wisconsin fee limits and HIPAA when fulfilling access requests through business associates. ([law.justia.com](https://law.justia.com/cases/wisconsin/supreme-court/2021/2019ap002034.html))

FAQs.

What fees can Wisconsin providers charge for paper medical records?

For July 1, 2026–June 30, 2027, providers may charge $1.48/page (first 25), $1.10/page (26–50), $0.72/page (51–100), and $0.42/page (101+). Microfiche/microfilm is $2.17/page; X‑ray prints are $14.56 each. If the requester is not the patient or a person authorized by the patient, one $11.68 certification fee and a $29.20 retrieval fee may be added, plus shipping and applicable taxes. ([dhs.wisconsin.gov](https://www.dhs.wisconsin.gov/health-care-coverage/records-fees.htm))

How does HIPAA define reasonable fees for records access?

HIPAA allows only a reasonable cost-based fee limited to copying labor, supplies, postage, and any requested summary/explanation. Search, retrieval, verification, system maintenance, and other overhead costs are excluded. These limits apply to individuals and their personal representatives. ([govinfo.gov](https://www.govinfo.gov/content/pkg/CFR-2025-title45-vol2/pdf/CFR-2025-title45-vol2-part164.pdf))

Are electronic medical records free in Wisconsin?

Yes—under state law, providers may not charge fees for electronic copies of patient health care records because § 146.83(3f) lists fees only for paper, microfiche/microfilm, and X‑ray formats. The Wisconsin Supreme Court confirmed this in 2023. ([wicourts.gov](https://www.wicourts.gov/sc/opinion/DisplayDocument.pdf?content=pdf&seqNo=641018))

What fee reductions apply for Medicaid or BadgerCare members?

When a member is enrolled on the date of the request, providers are limited to charging 25% of the applicable state‑capped fees for one set of copies; additional sets may be billed at 100%. Because Wisconsin prohibits provider charges for electronic copies, enrolled members should not be charged for electronic records. ([forwardhealth.wi.gov](https://www.forwardhealth.wi.gov/WIPortal/Subsystem/KW/Print.aspx?c=3&ia=1&nt=Member+Access+to+Records&p=1&s=1&sa=8))