• 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

Services and Requirements

Reimbursement Not Available

Wisconsin Medicaid may deny or recoup payment for covered services that fail to meet program requirements. Medicaid reimbursement is also not available for noncovered services.

The following are not reimbursable as PT, OT, or SLP services:

• Group PT.
• Group SLP for services other than expressive language, hearing auditory training, or receptive language.
• Facilitated communication.
• Auditory integration training.
• Services provided for the general good and welfare of recipients, including the following:
• General exercises to promote overall fitness and flexibility.
• Activities to provide diversion or general motivation.
• Crafts and other supplies used in OT services for inpatients in an institutional program.
• Formal educational services in academic and vocational subjects.
• Foot orthoses or orthopedic or corrective shoes for the following conditions:
• Flattened arches, regardless of the underlying pathology.
• Incomplete dislocation or subluxation metatarsalgia with no associated deformities.
• Arthritis with no associated deformities.
• Hypoallergenic conditions.
• Durable medical equipment that are not primarily medical in nature, including the following:
• Air conditioners and air purifiers.
• Auditory or listening music programs.
• Baby or infant exercise saucers.
• Ceiling lifts.
• Cleaning and disinfectant supplies.
• Cold air humidifiers.
• Computers.
• Copy machines.
• Dehumidifiers.
• Educational learning computer programs.
• Electric page turners.
• Emergency alert contact systems or services.
• Exercise and fitness equipment (stationary bicycles, treadmills, pulleys, weights, exercise therapy mats, rowing machines, physioballs, therapy putty, or therapy bands).
• Extended warranty.
• Fax machine.
• Home and environmental modifications (electronic or mechanical devices to control lighting, appliances, etc.).
• Homemaking equipment (microwaves, food carts, cutting boards, or other adaptive equipment for cooking, cleaning, etc.).
• Hydrocollator equipment or other devices for heat or cold, including hot and cold packs.
• Hypoallergenic items including bedding.
• Intercom monitors.
• Laptop computers.
• Lights, horns, flags, or signs for mobility bases.
• Pacemaker monitors.
• Playground and recreation equipment (swings, jungle gyms, tunnels, parachutes, obstacle courses, tricycles, or other adapted or specialized toys).
• Power door openers.
• Reading machines.
• Restraints.
• Ring walkers.
• Safety equipment (gait belts, harnesses, vests, alarm systems, wanderguard, medical alert bracelets or other types of monitoring equipment, or fences).
• Service animals.
• Telephone modems.
• Telephones, cellular phones, and speaker phones.
• Van or vehicle modifications.
• Video games.
• Durable medical equipment that are not generally accepted by the medical profession as being therapeutically effective. These items include heat and massage foam cushion pads.

Next — Codes, Procedure Codes
Previous — Services and Requirements, Services Not Separately Reimbursable