DHS 107.16(3)(e)7.7. 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.
DHS 107.16(3)(f)(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.
DHS 107.16(4)(4)Non-covered services. The following services are not covered services:
DHS 107.16(4)(a)(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;
DHS 107.16(4)(b)(b) Those services that can be performed by restorative nursing, as under s. DHS 132.60 (1) (b) through (d);
DHS 107.16(4)(c)(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;
DHS 107.16(4)(e)(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.
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)(a)5.5. Balance;
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;