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DHS 107.16 NoteNote: For more information on non-covered services, see s. DHS 107.03.
DHS 107.16 HistoryHistory: 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 107.17DHS 107.17Occupational therapy.
DHS 107.17(1)(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):
DHS 107.17(1)(a)(a) Motor skills, as follows:
DHS 107.17(1)(a)1.1. Range-of-motion;
DHS 107.17(1)(a)2.2. Gross/fine coordination;
DHS 107.17(1)(a)3.3. Strengthening;
DHS 107.17(1)(a)4.4. Endurance/tolerance; and
DHS 107.17(1)(b)(b) Sensory integrative skills, as follows:
DHS 107.17(1)(b)1.1. Reflex/sensory status;
DHS 107.17(1)(b)2.2. Body concept;
DHS 107.17(1)(b)3.3. Visual-spatial relationships;
DHS 107.17(1)(b)4.4. Posture and body integration; and
DHS 107.17(1)(b)5.5. Sensorimotor integration;
DHS 107.17(1)(c)(c) Cognitive skills, as follows:
DHS 107.17(1)(c)1.1. Orientation;
DHS 107.17(1)(c)2.2. Attention span;
DHS 107.17(1)(c)3.3. Problem-solving;
DHS 107.17(1)(c)4.4. Conceptualization; and
DHS 107.17(1)(c)5.5. Integration of learning;
DHS 107.17(1)(d)(d) Activities of daily living skills, as follows:
DHS 107.17(1)(d)1.1. Self-care;
DHS 107.17(1)(d)2.2. Work skills; and
DHS 107.17(1)(d)3.3. Avocational skills;
DHS 107.17(1)(e)(e) Social interpersonal skills, as follows:
DHS 107.17(1)(e)1.1. Dyadic interaction skills; and
DHS 107.17(1)(e)2.2. Group interaction skills;
DHS 107.17(1)(f)(f) Psychological intrapersonal skills, as follows:
DHS 107.17(1)(f)1.1. Self-identity and self-concept;
DHS 107.17(1)(f)2.2. Coping skills; and
DHS 107.17(1)(f)3.3. Independent living skills;
DHS 107.17(1)(g)(g) Preventive skills, as follows:
DHS 107.17(1)(g)1.1. Energy conservation;
DHS 107.17(1)(g)2.2. Joint protection;
DHS 107.17(1)(g)3.3. Edema control; and
DHS 107.17(1)(g)4.4. Positioning;
DHS 107.17(1)(h)(h) Therapeutic adaptions, as follows:
DHS 107.17(1)(h)1.1. Orthotics/splinting;
DHS 107.17(1)(h)2.2. Prosthetics;
DHS 107.17(1)(h)3.3. Assistive/adaptive equipment; and
DHS 107.17(1)(h)4.4. Environmental adaptations;
DHS 107.17(1)(i)(i) Environmental planning; and
DHS 107.17(1)(j)(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:
DHS 107.17(1)(j)1.1. Motor skills:
DHS 107.17(1)(j)1.a.a. Range-of-motion;
DHS 107.17(1)(j)1.b.b. Gross muscle test;
DHS 107.17(1)(j)1.c.c. Manual muscle test;
DHS 107.17(1)(j)1.d.d. Coordination evaluation;
DHS 107.17(1)(j)1.e.e. Nine hole peg test;
DHS 107.17(1)(j)1.f.f. Purdue pegboard test;
DHS 107.17(1)(j)1.g.g. Strength evaluation;
DHS 107.17(1)(j)1.h.h. Head-trunk balance evaluation;
DHS 107.17(1)(j)1.i.i. Standing balance — endurance;
DHS 107.17(1)(j)1.j.j. Sitting balance — endurance;
DHS 107.17(1)(j)1.k.k. Prosthetic check-out;
DHS 107.17(1)(j)1.L.L. Hemiplegic evaluation;
DHS 107.17(1)(j)1.m.m. Arthritis evaluation; and
DHS 107.17(1)(j)1.n.n. Hand evaluation — strength and range-of-motion;
DHS 107.17(1)(j)2.2. Sensory integrative skills:
DHS 107.17(1)(j)2.a.a. Beery test of visual motor integration;
DHS 107.17(1)(j)2.b.b. Southern California kinesthesia and tactile perception test;
DHS 107.17(1)(j)2.c.c. A. Milloni-Comparetti developmental scale;
DHS 107.17(1)(j)2.d.d. Gesell developmental scale;
DHS 107.17(1)(j)2.e.e. Southern California perceptual motor test battery;
DHS 107.17(1)(j)2.f.f. Marianne Frostig developmental test of visual perception;
DHS 107.17(1)(j)2.g.g. Reflex testing;
DHS 107.17(1)(j)2.h.h. Ayres space test;
DHS 107.17(1)(j)2.i.i. Sensory evaluation;
DHS 107.17(1)(j)2.j.j. Denver developmental test;
DHS 107.17(1)(j)2.k.k. Perceptual motor evaluation; and
DHS 107.17(1)(j)2.L.L. Visual field evaluation;
DHS 107.17(1)(j)3.3. Cognitive skills:
DHS 107.17(1)(j)3.a.a. Reality orientation assessment; and
DHS 107.17(1)(j)3.b.b. Level of cognition evaluation;
DHS 107.17(1)(j)4.4. Activities of daily living skills:
DHS 107.17(1)(j)4.a.a. Bennet hand tool evaluation;
DHS 107.17(1)(j)4.b.b. Crawford small parts dexterity test;
DHS 107.17(1)(j)4.c.c. Avocational interest and skill battery;
DHS 107.17(1)(j)4.d.d. Minnesota rate of manipulation; and
DHS 107.17(1)(j)4.e.e. ADL evaluation \ men and women;
DHS 107.17(1)(j)5.5. Social interpersonal skills — evaluation of response in group;
DHS 107.17(1)(j)6.6. Psychological intrapersonal skills:
DHS 107.17(1)(j)6.a.a. Subjective assessment of current emotional status;
DHS 107.17(1)(j)6.b.b. Azima diagnostic battery; and
DHS 107.17(1)(j)6.c.c. Goodenough draw-a-man test;
DHS 107.17(1)(j)7.7. Therapeutic adaptions; and
DHS 107.17(1)(j)8.8. Environmental planning — environmental evaluation.
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