Wisconsin Legislature: DHS 107.17(1)(c)5.

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

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6. Other therapies are providing sufficient services to meet the recipient’s functioning needs; or

7. The procedures requested are not medical in nature or are not covered services. Inappropriate diagnoses for therapy services and procedures of questionable medical necessity may not receive departmental authorization, depending upon the individual circumstances.

(f) Group physical therapy. Group physical therapy shall be a covered service. For purposes of this paragraph, “group physical therapy” means a physical therapy session at which there are more than one but not more than 10 recipients receiving services together from one or 2 providers. No more than 2 providers may be reimbursed for the same session. Physical therapy aides may not be reimbursed for group physical therapy.

(4) Non-covered services. The following services are not covered services:

(a) Services related to activities for the general good and welfare of recipients, such as general exercises to promote overall fitness and flexibility and activities to provide diversion or general motivation;

(b) Those services that can be performed by restorative nursing, as under s. DHS 132.60 (1) (b) through (d);

(c) Activities such as end-of-the-day clean-up time, transportation time, consultations and required paper reports. These are considered components of the provider’s overhead costs and are not covered as separately reimbursable items;

(e) When performed by a physical therapy aide, interpretation of physician referrals, patient evaluation, evaluation of procedures, initiation or adjustment of treatment, assumption of responsibility for planning patient care, or making entries in patient records.

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

History: Cr. Register, February, 1986, No 362, eff. 3-1-86; emerg. am. (2) (b), (d), (g), (3) (d) and (e) (intro.), eff. 7-1-88; am. (2) (b), (d), (g), (3) (d) and (e) (intro.), Register, December, 1988, No. 396, eff. 1-1-89; correction in (4) (b) made under s. 13.92 (4) (b) 7., Stats., Register December 2008 No. 636; 2021Wis. Act 225: cr. (3) (f), r. (4) (d)Register April 2022 No. 796, eff. 4-10-22; CR 22-043: am. (1) (a), renum. (1) (e) 3. a. to (1) (e) 3. and am., r. (1) (e) 3. b. Register May 2023 No. 809, eff. 6-1-23.

DHS 107.17 Occupational therapy.

(1) Covered services. Covered occupational therapy services are the following medically necessary services when prescribed by a physician and performed by a certified occupational therapist (OT) or by a certified occupational therapist assistant (COTA) under the direct, immediate, on-premises supervision of a certified occupational therapist or, for services under par. (d), by a certified occupational therapist assistant under the general supervision of a certified occupational therapist pursuant to the requirements of s. DHS 105.28 (2):

(a) Motor skills, as follows:

1. Range-of-motion;

2. Gross/fine coordination;

3. Strengthening;

4. Endurance/tolerance; and

5. Balance;

(b) Sensory integrative skills, as follows:

1. Reflex/sensory status;

2. Body concept;

3. Visual-spatial relationships;

4. Posture and body integration; and

5. Sensorimotor integration;

1. Orientation;

2. Attention span;

3. Problem-solving;

4. Conceptualization; and

5. Integration of learning;

(d) Activities of daily living skills, as follows:

1. Self-care;

2. Work skills; and

3. Avocational skills;

(e) Social interpersonal skills, as follows:

1. Dyadic interaction skills; and

2. Group interaction skills;

(f) Psychological intrapersonal skills, as follows:

1. Self-identity and self-concept;

2. Coping skills; and

3. Independent living skills;

(g) Preventive skills, as follows:

1. Energy conservation;

2. Joint protection;

3. Edema control; and

4. Positioning;

(h) Therapeutic adaptions, as follows:

1. Orthotics/splinting;

2. Prosthetics;

3. Assistive/adaptive equipment; and

4. Environmental adaptations;

(i) Environmental planning; and

(j) Evaluations or re-evaluations. Covered evaluations, the results of which shall be set out in a written report attached to the test chart or form in the recipient’s medical record, are the following:

1. Motor skills:

a. Range-of-motion;

b. Gross muscle test;

c. Manual muscle test;

d. Coordination evaluation;

e. Nine hole peg test;

f. Purdue pegboard test;

g. Strength evaluation;

h. Head-trunk balance evaluation;

i. Standing balance — endurance;

j. Sitting balance — endurance;

k. Prosthetic check-out;

L. Hemiplegic evaluation;

m. Arthritis evaluation; and

n. Hand evaluation — strength and range-of-motion;

2. Sensory integrative skills:

a. Beery test of visual motor integration;

b. Southern California kinesthesia and tactile perception test;

c. A. Milloni-Comparetti developmental scale;

d. Gesell developmental scale;

e. Southern California perceptual motor test battery;

f. Marianne Frostig developmental test of visual perception;

g. Reflex testing;

h. Ayres space test;

i. Sensory evaluation;

j. Denver developmental test;

k. Perceptual motor evaluation; and

L. Visual field evaluation;

3. Cognitive skills:

a. Reality orientation assessment; and

b. Level of cognition evaluation;

4. Activities of daily living skills:

a. Bennet hand tool evaluation;

b. Crawford small parts dexterity test;

c. Avocational interest and skill battery;

d. Minnesota rate of manipulation; and