• 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

Appendix

• Appendix 1 — Certification Requirements and Reimbursement Information for Physical Therapy, Occupational Therapy
• Appendix 2 — Allowable Services and Supervision Requirements for Assistants, Students, and Aides
• Appendix 3 — Declaration of Supervision for Nonbilling Providers Instructions
• Appendix 4 —  Declaration of Supervision for Nonbilling Providers Form
• Appendix 5 — Request for Waiver of Physical Therapist Assistant and Occupational Therapy Assistant Supervision Requirements Form
• Appendix 6 — Medicaid Therapy Services for Children
• Appendix 7 — A Guide to Obtaining Augmentative Communication Devices and Accessories Through Wisconsin Medicaid
• Appendix 8 — Allowable Procedure Codes for Physical Therapy Services
• Appendix 9 — Allowable Procedure Codes for Occupational Therapy Services
• Appendix 10 — Allowable Procedure Codes for Speech and Language Pathology Services
• Appendix 11 — Allowable Physical Therapy Procedure Codes for Birth to 3 Services
• Appendix 12 — Allowable Occupational Therapy Procedure Codes for Birth to 3 Services
• Appendix 13 — Allowable Speech and Language Pathology Procedure Codes for Birth to 3 Services
• Appendix 14 — Allowable Modifiers for Physical Therapy, Occupational Therapy, and Speech and Language Pathology Services
• Appendix 15 — Allowable Place of Service Codes for Physical Therapy, Occupational Therapy, and Speech and Language Pathology Services
• Appendix 16 — Examples of Standards of Medical Necessity As Evaluated on Prior Authorization Requests
• Appendix 17 — General Principles for Physical Therapy, Occupational Therapy, and Speech and Language Pathology Prior Authorization Requests
• Appendix 18 — Extension of Therapy vs. Spell of Illness
• Appendix 19 — Allowable ICD-9-CM Codes for Physical Therapy Spell of Illness Approval (Organized by Codes)
• Appendix 20 — Allowable ICD-9-CM Codes for Physical Therapy Spell of Illness Approval (Organized by Statements)
• Appendix 21 — Allowable ICD-9-CM Codes for Occupational  Therapy Spell of Illness Approval (Organized by Codes)
• Appendix 22 — Allowable ICD-9-CM Codes for Occupational  Therapy Spell of Illness Approval (Organized by Statements)
• Appendix 23 — Allowable ICD-9-CM Codes for Speech and Language Pathology Spell of Illness Approval (Organized by Codes)
• Appendix 24 — Allowable ICD-9-CM Codes for Speech and Language Pathology Spell of Illness Approval (Organized by Statements)
• Appendix 25 — Prior Authorization Request Form (PA/RF) Completion Instructions for Physical Therapy, Occupational Therapy, and Speech and Language Pathology Services
• Appendix 26 — Sample Prior Authorization Request Form (PA/RF) for Physical Therapy Services
• Appendix 27 — Sample Prior Authorization Request Form (PA/RF) for Occupational Therapy Services
• Appendix 28 — Sample Prior Authorization Request Form (PA/RF) for Speech and Language Pathology Services
• Appendix 29 — Prior Authorization/Therapy Attachment (PA/TA) Completion Instructions
• Appendix 30 — Prior Authorization/Therapy Attachment (PA/TA)
• Appendix 31 — Prior Authorization/Spell of Illness Attachment (PA/SOIA) Completion Instructions
• Appendix 32 — Prior Authorization/Spell of Illness Attachment (PA/SOIA)
• Appendix 33 — Prior Authorization/Birth to 3 Therapy Attachment (PA/B3)
• Appendix 34 — CMS 1500 Claim Form Instructions for Physical Therapy, Occupational Therapy, and Speech and Language Pathology Services
• Appendix 35 — Sample CMS 1500 Claim Form for Physical Therapy Services
• Appendix 36 — Sample CMS 1500 Claim Form for Occupational Therapy Services
• Appendix 37 — Sample CMS 1500 Claim Form for Speech and Language Pathology Services
• Appendix 38 — General Information About the Birth to 3 Program
• Appendix 39 — Procedures to Follow When the Birth to 3 Agency Pays the Commercial Health Insurance Liability

Physical Therapy, Occupational Therapy, and
Speech and Language Pathology Services
January 2006