DHS 107.16(1)(a)(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. DHS 107.16(1)(b)(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: