• Certification and Ongoing Responsibilities
  • Introduction
  • Other Facilities
  • Responsibilities
  • Supervision Requirements
    • Introduction
    • Declaration of Supervision
    • Supervision Waiver
  • Durable Medical Equipment and Disposable Medical Supplies
• Provider Communication
  • Introduction
  • Coordination with School-Based Services Providers
  • Coordination with County Birth to 3 Programs
  • Therapy Services for Children Brochure
  • Guide to Obtaining Augmentative Communication Devices and Accessories
  • Directory of Used Medical Equipment
• Documentation Requirements
  • Introduction
  • Prescriptions
  • Evaluations
  • Plan of Care
  • Daily Entries
• Services and Requirements
  • Introduction
  • Initial Spell of Illness
  • Daily Limitations
  • Duplicate Services
  • Evaluations
  • Group Therapy
  • Natural Environments
  • Durable Medical Equipment and Disposable Medical Supplies
  • HealthCheck "Other Services"
  • Services Not Separately Reimbursable
  • Reimbursement Not Available
• Codes
  • Procedure Codes
    • Introduction
    • Unit of Service
  • Modifiers
  • Place of Service Codes
  • Diagnosis Codes
• Prior Authorization
  • Introduction
  • Prior Authorization Forms and Attachments
  • Medical Necessity
    • Introduction
    • Relationship of Medical Necessity to Clinical Practice Principles
  • Flexibility of Approved Services
    • Introduction
    • Plan of Care Must Reflect Flexibility of Approved Services
    • Duration of Approved Services
    • Coordinating Multiple Prior Authorization Requests
• Requesting Extension of Therapy, Maintenance Therapy, and Services That Always Require Prior Authorization
  • Introduction
  • Approval Criteria
  • Extension of Therapy
  • Maintenance Therapy
    • Introduction
    • Direct Maintenance
    • Monitoring Maintenance
    • Discontinuing Maintenance
  • Services That Always Require Prior Authorization
    • Introduction
    • Cotreatment
    • Dual Treatment
    • Unlisted Procedure Codes
    • Decubitus Ulcers
• Requesting Spell of Illness
  • Introduction
  • Maximum Allowable Treatment Days
    • Introduction
    • Unused Treatment Days
• Extension of Therapy vs. Spell of Illness
• Requesting Services for Birth to 3 Participants
  • Introduction
  • Situations That Do Not Qualify for Birth to 3
• Requesting Amendments
  • Introduction
  • Approval Criteria
  • Reasons for Denial
• Claims
  • Introduction
  • 837 Health Care Claim: Professional
  • CMS 1500
  • Provider Numbers
    • Individual Providers
    • Groups, Clinics, and Nursing Homes
    • Rehabilitation Agencies
    • Hospitals
  • Referring Provider
  • Evaluations
  • Services Provided Beyond Daily Limits
  • Unlisted Procedure Codes
  • Multiple Services During One Session
  • Submitting Claims for Birth to 3 Services
• Reimbursement
  • Maximum Allowable Fees
  • Reimbursement Methods
    • Introduction
    • Natural Environment Enhanced Reimbursement
  • Copayment
    • Introduction
    • Annual Copayment Maximum
• Appendix
• PDF

Requesting Services for Birth to 3 Participants

Physical therapy (PT), occupational therapy (OT), and speech and language pathology (SLP) providers should submit the Prior Authorization/Birth to 3 Therapy Attachment (PA/B3), HCF 11011 (fillable PDF, 37 KB), for Birth to 3 (B-3) services.

The PA/B3 is located in Appendix 33 of this handbook for photocopying and may also be downloaded and printed from the Medicaid Web site.

Providers receive a real-time decision for approved B-3 services requested via the Web. Providers should refer to the Medicaid Web site for more information about Web submission.

Wisconsin Medicaid requires PT, OT, and SLP providers to submit a PA request only once per child, per therapy discipline, per billing provider for recipients who participate in the B-3 Program. An approved PA is granted up to the recipient’s third birthday.

Birth to 3 services must be provided by Medicaid PT, OT, and SLP providers who are employed by, or under agreement with, a B-3 agency to provide B-3 services. In addition, the B-3 services must be one or both of the following:

• Provided in conjunction with the B-3 initial evaluation and assessment in accordance with HFS 90, Wis. Admin. Code, even if the evaluation and assessment determines the child is not eligible for B-3 services.
• Identified in the recipient’s Individualized Family Service Plan (IFSP) and performed at the same frequency, intensity, and duration listed in the IFSP. Wisconsin Medicaid will not reimburse the provider beyond the frequency and duration specified in the prescription or the physician-signed plan of care.

Providers may submit the PA/B3 in either of the following situations:

• At any time once an evaluation or a PT, OT, or SLP service has been initiated through the B-3 Program.
• Two to four weeks before the child’s initial 35 treatment days per discipline have been used.

Next — Requesting Services for Birth to 3 Participants, Situations That Do Not Qualify for Birth to 3
Previous — Extension of Therapy vs. Spell of Illness