Chapter DHS 107

DHS 107.15 Note Note: For more information on non-covered services, see s. DHS 107.03.

DHS 107.15 History History: Cr. Register, February, 1986, No. 362, eff. 3-1-86; correction in (2) made under s. 13.92 (4) (b) 7., Stats., Register December 2008 No. 636.

DHS 107.16 DHS 107.16 Physical therapy.

DHS 107.16(1) (1) Covered services.

DHS 107.16(1)(a) (a) General. Covered physical therapy services are those medically necessary modalities, procedures and evaluations enumerated in pars. (b) to (d), when prescribed by a physician and performed by a qualified physical therapist (PT) or a certified physical therapy assistant under the supervision of a physical therapist pursuant to s. PT 5.01. Specific services performed by a physical therapy aide under par. (e) are covered when provided in accordance with supervision requirements under par. (e) 3.

DHS 107.16(1)(b) (b) Evaluations. Covered evaluations, the results of which shall be set out in a written report to accompany the test chart or form in the recipient’s medical record, are the following:

DHS 107.16(1)(b)1. 1. Stress test;

DHS 107.16(1)(b)2. 2. Orthotic check-out;

DHS 107.16(1)(b)3. 3. Prosthetic check-out;

DHS 107.16(1)(b)4. 4. Functional evaluation;

DHS 107.16(1)(b)5. 5. Manual muscle test;

DHS 107.16(1)(b)6. 6. Isokinetic evaluation;

DHS 107.16(1)(b)7. 7. Range-of-motion measure;

DHS 107.16(1)(b)8. 8. Length measurement;

DHS 107.16(1)(b)9. 9. Electrical testing:

DHS 107.16(1)(b)9.a. a. Nerve conduction velocity;

DHS 107.16(1)(b)9.b. b. Strength duration curve — chronaxie;

DHS 107.16(1)(b)9.c. c. Reaction of degeneration;

DHS 107.16(1)(b)9.d. d. Jolly test (twitch tetanus); and

DHS 107.16(1)(b)9.e. e. “H” test;

DHS 107.16(1)(b)10. 10. Respiratory assessment;

DHS 107.16(1)(b)11. 11. Sensory evaluation;

DHS 107.16(1)(b)12. 12. Cortical integration evaluation;

DHS 107.16(1)(b)13. 13. Reflex testing;

DHS 107.16(1)(b)14. 14. Coordination evaluation;

DHS 107.16(1)(b)15. 15. Posture analysis;

DHS 107.16(1)(b)16. 16. Gait analysis;

DHS 107.16(1)(b)17. 17. Crutch fitting;

DHS 107.16(1)(b)18. 18. Cane fitting;

DHS 107.16(1)(b)19. 19. Walker fitting;

DHS 107.16(1)(b)20. 20. Splint fitting;

DHS 107.16(1)(b)21. 21. Corrective shoe fitting or orthopedic shoe fitting;

DHS 107.16(1)(b)22. 22. Brace fitting assessment;

DHS 107.16(1)(b)23. 23. Chronic-obstructive pulmonary disease evaluation;

DHS 107.16(1)(b)24. 24. Hand evaluation;

DHS 107.16(1)(b)25. 25. Skin temperature measurement;

DHS 107.16(1)(b)26. 26. Oscillometric test;

DHS 107.16(1)(b)27. 27. Doppler peripheral-vascular evaluation;

DHS 107.16(1)(b)28. 28. Developmental evaluation:

DHS 107.16(1)(b)28.a. a. Millani-Comparetti evaluation;

DHS 107.16(1)(b)28.b. b. Denver developmental;

DHS 107.16(1)(b)28.c. c. Ayres;

DHS 107.16(1)(b)28.d. d. Gessell;

DHS 107.16(1)(b)28.e. e. Kephart and Roach;

DHS 107.16(1)(b)28.f. f. Bazelton scale;

DHS 107.16(1)(b)28.g. g. Bailey scale; and

DHS 107.16(1)(b)28.h. h. Lincoln Osteretsky motion development scale;

DHS 107.16(1)(b)29. 29. Neuro-muscular evaluation;

DHS 107.16(1)(b)30. 30. Wheelchair fitting — evaluation, prescription, modification, adaptation;

DHS 107.16(1)(b)31. 31. Jobst measurement;

DHS 107.16(1)(b)32. 32. Jobst fitting;

DHS 107.16(1)(b)33. 33. Perceptual evaluation;

DHS 107.16(1)(b)34. 34. Pulse volume recording;

DHS 107.16(1)(b)35. 35. Physical capacities testing;

DHS 107.16(1)(b)36. 36. Home evaluation;

DHS 107.16(1)(b)37. 37. Garment fitting;

DHS 107.16(1)(b)38. 38. Pain; and

DHS 107.16(1)(b)39. 39. Arthrokinematic.

DHS 107.16(1)(c) (c) Modalities. Covered modalities are the following:

DHS 107.16(1)(c)1. 1. Hydrotherapy:

DHS 107.16(1)(c)1.a. a. Hubbard tank, unsupervised; and

DHS 107.16(1)(c)1.b. b. Whirlpool;

DHS 107.16(1)(c)2. 2. Electrotherapy:

DHS 107.16(1)(c)2.a. a. Biofeedback; and

DHS 107.16(1)(c)2.b. b. Electrical stimulation — transcutaneous nerve stimulation, medcolator;

DHS 107.16(1)(c)3. 3. Exercise therapy:

DHS 107.16(1)(c)3.a. a. Finger ladder;

DHS 107.16(1)(c)3.b. b. Overhead pulley;

DHS 107.16(1)(c)3.c. c. Restorator;

DHS 107.16(1)(c)3.d. d. Shoulder wheel;

DHS 107.16(1)(c)3.e. e. Stationary bicycle;

DHS 107.16(1)(c)3.f. f. Wall weights;

DHS 107.16(1)(c)3.g. g. Wand exercises;

DHS 107.16(1)(c)3.h. h. Static stretch;

DHS 107.16(1)(c)3.i. i. Elgin table;

DHS 107.16(1)(c)3.j. j. N-k table;

DHS 107.16(1)(c)3.k. k. Resisted exercise;

DHS 107.16(1)(c)3.L. L. Progressive resistive exercise;

DHS 107.16(1)(c)3.m. m. Weighted exercise;

DHS 107.16(1)(c)3.n. n. Orthotron;

DHS 107.16(1)(c)3.o. o. Kinetron;

DHS 107.16(1)(c)3.p. p. Cybex;

DHS 107.16(1)(c)3.q. q. Skate or powder board;

DHS 107.16(1)(c)3.r. r. Sling suspension modalities; and

DHS 107.16(1)(c)3.s. s. Standing table;

DHS 107.16(1)(c)4. 4. Mechanical apparatus:

DHS 107.16(1)(c)4.a. a. Cervical and lumbar traction; and

DHS 107.16(1)(c)4.b. b. Vasoneumatic pressure treatment;

DHS 107.16(1)(c)5. 5. Thermal therapy: