Wisconsin Legislature: DHS 107.16(1)(d)6.b.

Alert! This chapter may be affected by an emergency rule:

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h. Frenkel’s exercise;

i. In-water exercises;

j. Mat exercises;

k. Neurodevelopmental exercise;

L. Neuromuscular exercise;

m. Post-natal exercise;

n. Postural exercises;

o. Pre-natal exercises;

p. Range-of-motion exercises;

q. Relaxation exercises;

r. Relaxation techniques;

s. Thoracic outlet exercises;

t. Back exercises;

u. Stretching exercises;

v. Pre-ambulation exercises;

w. Pulmonary rehabilitation program; and

x. Stall bar exercise;

4. Mechanical apparatus:

a. Intermittent positive pressure breathing;

b. Tilt or standing table;

c. Ultra-sonic nebulizer;

d. Ultra-violet; and

e. Phonophoresis;

5. Thermal:

a. Cryotherapy — ice massage, supervised;

b. Medcosonulator; and

c. Ultra-sound;

6. Manual application:

a. Acupressure, also known as shiatsu;

b. Adjustment of traction apparatus;

c. Application of traction apparatus;

d. Manual traction;

e. Massage;

f. Mobilization;

g. Perceptual facilitation;

h. Percussion (tapotement), vibration;

i. Strapping — taping, bandaging;

j. Stretching;

k. Splinting; and

L. Casting;

7. Neuromuscular techniques:

a. Balance training;

b. Muscle reeducation;

c. Neurodevelopmental techniques — PNR, Rood, Temple-Fay, Doman-Delacato, Cabot, Bobath;

d. Perceptual training;

e. Sensori-stimulation; and

f. Facilitation techniques;

8. Ambulation training:

a. Gait training with crutch, cane or walker;

b. Gait training for level, incline or stair climbing; and

c. Gait training on parallel bars; and

9. Miscellaneous:

a. Aseptic or sterile procedures;

b. Functional training, also known as activities of daily living — self-care training, transfers and wheelchair independence;

c. Orthotic training;

d. Positioning;

e. Posture training;

f. Preprosthetic training — desensitization;

g. Preprosthetic training — strengthening;

h. Preprosthetic training — wrapping;

i. Prosthetic training;

j. Postural drainage; and

k. Home program.

(e) Physical therapy aide services.

1. Services which are reimbursable when performed by a physical therapy aide meeting the requirements of subds. 2. and 3. are the following:

a. Performing simple activities required to prepare a recipient for treatment, assist in the performance of treatment, or assist at the conclusion of treatment, such as assisting the recipient to dress or undress, transferring a recipient to or from a mat, and applying or removing orthopedic devices;

Note: Transportation of the recipient to or from the area in which therapy services are provided is not reimbursable.

b. Assembling and disassembling equipment and accessories in preparation for treatment or after treatment has taken place;

Note: Examples of activities are adjustment of restorator, N.K. table, cybex, weights and weight boots for the patient, and the filling, cleaning and emptying of whirlpools.

c. Assisting with the use of equipment and performing simple modalities once the recipient’s program has been established and the recipient’s response to the equipment or modality is highly predictable; and

Note: Examples of activities are application of hot or cold packs, application of paraffin, assisting recipient with whirlpool, tilt table, weights and pulleys.

d. Providing protective assistance during exercise, activities of daily living, and ambulation activities related to the development of strength and refinement of activity.

Note: Examples of activities are improving recipient’s gait safety and functional distance technique through repetitious gait training and increasing recipient’s strength through the use of such techniques as weights, pulleys, and cane exercises.

2. The physical therapy aide shall be trained in a manner appropriate to his or her job duties. The supervising therapist is responsible for the training of the aide or for securing documentation that the aide has been trained by a physical therapist. The supervising therapist is responsible for determining and monitoring the aide’s competency to perform assigned duties. The supervising therapist shall document in writing the modalities or activities for which the aide has received training.

3. The physical therapy aide shall provide services under the supervision of a physical therapist under s. PT 5.02.

4. Physical therapy aides may not bill or be reimbursed directly for their services.

(2) Services requiring prior authorization.

(a) Definition. In this subsection, “spell of illness” means a condition characterized by a demonstrated loss of functional ability to perform daily living skills, caused by a new disease, injury or medical condition or by an increase in the severity of a pre-existing medical condition. For a condition to be classified as a new spell of illness, the recipient must display the potential to reachieve the skill level that he or she had previously.

(b) Requirement. Prior authorization is required under this subsection for physical therapy services provided to an MA recipient in excess of 35 treatment days per spell of illness, except that physical therapy services provided to an MA recipient who is a hospital inpatient or who is receiving physical therapy services provided by a home health agency are not subject to prior authorization under this subsection.

Note: Physical therapy services provided by a home health agency are subject to prior authorization under s. DHS 107.11 (3).

(c) Conditions justifying spell of illness designation. The following conditions may justify designation of a new spell of illness:

1. An acute onset of a new disease, injury or condition such as:

a. Neuromuscular dysfunction, including stroke-hemiparesis, multiple sclerosis, Parkinson’s disease and diabetic neuropathy;

b. Musculoskeletal dysfunction, including fracture, amputation, strains and sprains, and complications associated with surgical procedures; or

c. Problems and complications associated with physiologic dysfunction, including severe pain, vascular conditions, and cardio-pulmonary conditions.

2. An exacerbation of a pre-existing condition, including but not limited to the following, which requires physical therapy intervention on an intensive basis:

a. Multiple sclerosis;

b. Rheumatoid arthritis; or

c. Parkinson’s disease.