Wisconsin Legislature: DHS 107.16(1)(b)23.

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

EmR2421

(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.

(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:

1. Stress test;

2. Orthotic check-out;

3. Prosthetic check-out;

4. Functional evaluation;

5. Manual muscle test;

6. Isokinetic evaluation;

7. Range-of-motion measure;

8. Length measurement;

9. Electrical testing:

a. Nerve conduction velocity;

b. Strength duration curve — chronaxie;

c. Reaction of degeneration;

d. Jolly test (twitch tetanus); and

e. “H” test;

10. Respiratory assessment;

11. Sensory evaluation;

12. Cortical integration evaluation;

13. Reflex testing;

14. Coordination evaluation;

15. Posture analysis;

16. Gait analysis;

17. Crutch fitting;

18. Cane fitting;

19. Walker fitting;

20. Splint fitting;

21. Corrective shoe fitting or orthopedic shoe fitting;

22. Brace fitting assessment;

23. Chronic-obstructive pulmonary disease evaluation;

24. Hand evaluation;

25. Skin temperature measurement;

26. Oscillometric test;

27. Doppler peripheral-vascular evaluation;

28. Developmental evaluation:

a. Millani-Comparetti evaluation;

b. Denver developmental;

c. Ayres;

d. Gessell;

e. Kephart and Roach;

f. Bazelton scale;

g. Bailey scale; and

h. Lincoln Osteretsky motion development scale;

29. Neuro-muscular evaluation;

30. Wheelchair fitting — evaluation, prescription, modification, adaptation;

31. Jobst measurement;

32. Jobst fitting;

33. Perceptual evaluation;

34. Pulse volume recording;

35. Physical capacities testing;

36. Home evaluation;

37. Garment fitting;

38. Pain; and

39. Arthrokinematic.

1. Hydrotherapy:

a. Hubbard tank, unsupervised; and

b. Whirlpool;

2. Electrotherapy:

a. Biofeedback; and

b. Electrical stimulation — transcutaneous nerve stimulation, medcolator;

3. Exercise therapy:

a. Finger ladder;

b. Overhead pulley;

c. Restorator;

d. Shoulder wheel;

e. Stationary bicycle;

f. Wall weights;

g. Wand exercises;

h. Static stretch;

i. Elgin table;

j. N-k table;

k. Resisted exercise;

L. Progressive resistive exercise;

m. Weighted exercise;

n. Orthotron;

o. Kinetron;

p. Cybex;

q. Skate or powder board;

r. Sling suspension modalities; and

s. Standing table;

4. Mechanical apparatus:

a. Cervical and lumbar traction; and

b. Vasoneumatic pressure treatment;

5. Thermal therapy:

a. Baker;

b. Cryotherapy — ice immersion or cold packs;

c. Diathermy;

d. Hot pack — hydrocollator pack;