Wisconsin Legislature: DHS 107.16(1)(b)8.

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

EmR2421

2. Prior authorization is required for spinal supports which have been prescribed by a physician or chiropractor if the purchase or rental price of a support is over $75. Rental costs under $75 shall be paid for one month without prior approval.

(b) Conditions justifying spell of illness designation. The following conditions may justify designation of a new spell of illness if treatment for the condition is medically necessary:

1. An acute onset of a new spinal subluxation;

2. An acute onset of an aggravation of pre-existing spinal subluxation by injury; or

3. An acute onset of a change in pre-existing spinal subluxation based on objective findings.

(c) Onset and termination of spell of illness. The spell of illness begins with the first day of treatment or evaluation following the onset of a condition under par. (b) and ends when the recipient improves so that treatment by a chiropractor for the condition causing the spell of illness is no longer medically necessary, or after 20 spinal manipulations, whichever comes first.

(d) Documentation. The chiropractor shall document the spell of illness in the patient plan of care.

(e) Non-transferability of treatment days. Unused treatment days from one spell of illness shall not be carried over into a new spell of illness.

(f) Other coverage. Treatment days covered by medicare or other third-party insurance shall be included in computing the 20 spinal manipulation per spell of illness total.

(g) Department expertise. The department may have on its staff qualified chiropractors to develop prior authorization criteria and perform other consultative activities.

Note: For more information on prior authorization, see s. DHS 107.02 (3).

(4) Other limitations.

(a) An x-ray or set of x-rays, such as anterior-posterior and lateral, is a covered service only for an initial visit if the x-ray is performed either in the course of diagnosing a spinal subluxation or in the course of verifying symptoms of other medical conditions beyond the scope of chiropractic.

(b) A diagnostic urinalysis is a covered service only for an initial office visit when related to the diagnosis of a spinal subluxation, or when verifying a symptomatic condition beyond the scope of chiropractic.

(c) The billing for an initial office visit shall clearly describe all procedures performed to ensure accurate reimbursement.

(5) Non-covered services. Consultations between providers regarding a diagnosis or treatment are not covered services.

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

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 Physical therapy.

(1) Covered services.

(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;