Chapter DHS 107

DHS 107.16(1)(d) (d) Procedures. Covered procedures are the following:

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

DHS 107.16(1)(d)1.a. a. Contrast bath;

DHS 107.16(1)(d)1.b. b. Hubbard tank, supervised;

DHS 107.16(1)(d)1.c. c. Whirlpool, supervised; and

DHS 107.16(1)(d)1.d. d. Walking tank;

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

DHS 107.16(1)(d)2.a. a. Biofeedback;

DHS 107.16(1)(d)2.b. b. Electrical stimulation, supervised;

DHS 107.16(1)(d)2.c. c. Iontophoresis (ion transfer);

DHS 107.16(1)(d)2.d. d. Transcutaneous nerve stimulation (TNS), supervised;

DHS 107.16(1)(d)2.e. e. Electrogalvanic stimulation;

DHS 107.16(1)(d)2.f. f. Hyperstimulation analgesia; and

DHS 107.16(1)(d)2.g. g. Interferential current;

DHS 107.16(1)(d)3. 3. Exercise:

DHS 107.16(1)(d)3.a. a. Peripheral vascular exercises (Beurger-Allen);

DHS 107.16(1)(d)3.b. b. Breathing exercises;

DHS 107.16(1)(d)3.c. c. Cardiac rehabilitation — immediate post-discharge from hospital;

DHS 107.16(1)(d)3.d. d. Cardiac rehabilitation — conditioning rehabilitation program;

DHS 107.16(1)(d)3.e. e. Codman’s exercise;

DHS 107.16(1)(d)3.f. f. Coordination exercises;

DHS 107.16(1)(d)3.g. g. Exercise — therapeutic (active, passive, active assistive, resistive);

DHS 107.16(1)(d)3.h. h. Frenkel’s exercise;

DHS 107.16(1)(d)3.i. i. In-water exercises;

DHS 107.16(1)(d)3.j. j. Mat exercises;

DHS 107.16(1)(d)3.k. k. Neurodevelopmental exercise;

DHS 107.16(1)(d)3.L. L. Neuromuscular exercise;

DHS 107.16(1)(d)3.m. m. Post-natal exercise;

DHS 107.16(1)(d)3.n. n. Postural exercises;

DHS 107.16(1)(d)3.o. o. Pre-natal exercises;

DHS 107.16(1)(d)3.p. p. Range-of-motion exercises;

DHS 107.16(1)(d)3.q. q. Relaxation exercises;

DHS 107.16(1)(d)3.r. r. Relaxation techniques;

DHS 107.16(1)(d)3.s. s. Thoracic outlet exercises;

DHS 107.16(1)(d)3.t. t. Back exercises;

DHS 107.16(1)(d)3.u. u. Stretching exercises;

DHS 107.16(1)(d)3.v. v. Pre-ambulation exercises;

DHS 107.16(1)(d)3.w. w. Pulmonary rehabilitation program; and

DHS 107.16(1)(d)3.x. x. Stall bar exercise;

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

DHS 107.16(1)(d)4.a. a. Intermittent positive pressure breathing;

DHS 107.16(1)(d)4.b. b. Tilt or standing table;

DHS 107.16(1)(d)4.c. c. Ultra-sonic nebulizer;

DHS 107.16(1)(d)4.d. d. Ultra-violet; and

DHS 107.16(1)(d)4.e. e. Phonophoresis;

DHS 107.16(1)(d)5. 5. Thermal:

DHS 107.16(1)(d)5.a. a. Cryotherapy — ice massage, supervised;

DHS 107.16(1)(d)5.b. b. Medcosonulator; and

DHS 107.16(1)(d)5.c. c. Ultra-sound;

DHS 107.16(1)(d)6. 6. Manual application:

DHS 107.16(1)(d)6.a. a. Acupressure, also known as shiatsu;

DHS 107.16(1)(d)6.b. b. Adjustment of traction apparatus;

DHS 107.16(1)(d)6.c. c. Application of traction apparatus;

DHS 107.16(1)(d)6.d. d. Manual traction;

DHS 107.16(1)(d)6.e. e. Massage;

DHS 107.16(1)(d)6.f. f. Mobilization;

DHS 107.16(1)(d)6.g. g. Perceptual facilitation;

DHS 107.16(1)(d)6.h. h. Percussion (tapotement), vibration;

DHS 107.16(1)(d)6.i. i. Strapping — taping, bandaging;

DHS 107.16(1)(d)6.j. j. Stretching;

DHS 107.16(1)(d)6.k. k. Splinting; and

DHS 107.16(1)(d)6.L. L. Casting;

DHS 107.16(1)(d)7. 7. Neuromuscular techniques:

DHS 107.16(1)(d)7.a. a. Balance training;

DHS 107.16(1)(d)7.b. b. Muscle reeducation;

DHS 107.16(1)(d)7.c. c. Neurodevelopmental techniques — PNR, Rood, Temple-Fay, Doman-Delacato, Cabot, Bobath;

DHS 107.16(1)(d)7.d. d. Perceptual training;

DHS 107.16(1)(d)7.e. e. Sensori-stimulation; and

DHS 107.16(1)(d)7.f. f. Facilitation techniques;

DHS 107.16(1)(d)8. 8. Ambulation training:

DHS 107.16(1)(d)8.a. a. Gait training with crutch, cane or walker;

DHS 107.16(1)(d)8.b. b. Gait training for level, incline or stair climbing; and

DHS 107.16(1)(d)8.c. c. Gait training on parallel bars; and

DHS 107.16(1)(d)9. 9. Miscellaneous:

DHS 107.16(1)(d)9.a. a. Aseptic or sterile procedures;

DHS 107.16(1)(d)9.b. b. Functional training, also known as activities of daily living — self-care training, transfers and wheelchair independence;

DHS 107.16(1)(d)9.c. c. Orthotic training;

DHS 107.16(1)(d)9.d. d. Positioning;

DHS 107.16(1)(d)9.e. e. Posture training;

DHS 107.16(1)(d)9.f. f. Preprosthetic training — desensitization;

DHS 107.16(1)(d)9.g. g. Preprosthetic training — strengthening;

DHS 107.16(1)(d)9.h. h. Preprosthetic training — wrapping;

DHS 107.16(1)(d)9.i. i. Prosthetic training;

DHS 107.16(1)(d)9.j. j. Postural drainage; and

DHS 107.16(1)(d)9.k. k. Home program.

DHS 107.16(1)(e) (e) Physical therapy aide services.

DHS 107.16(1)(e)1. 1. Services which are reimbursable when performed by a physical therapy aide meeting the requirements of subds. 2. and 3. are the following:

DHS 107.16(1)(e)1.a. 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;

DHS 107.16 Note Note: Transportation of the recipient to or from the area in which therapy services are provided is not reimbursable.