• 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 Extension of Therapy, Maintenance Therapy, and Services That Always Require Prior Authorization

Services That Always Require Prior Authorization

Cotreatment

Cotreatment (interdisciplinary treatment) always requires PA. Cotreatment is simultaneous treatment by two providers of different therapy disciplines during the same time period. Cotreatment may be authorized when the treatment approach is medically necessary to optimize the recipient’s benefit from therapy.

Each of the providers involved in cotreatment is required to complete a separate PA request; the requests must be submitted at the same time. Providers may either mail the PA requests in the same envelope or fax them at the same time. The Prior Authorization Request Forms (PA/RFs), HCF 11018, may be submitted via the Web if both PA requests are mailed together or faxed at the same time.

Each provider’s PA request for cotreatment must include the following:

• A specific request for cotreatment.
• Documentation verifying the following:
• Individual treatment from a single PT, OT, or SLP provider does not provide maximum benefit to the recipient.
• Services of two different therapy disciplines, simultaneously performed, are required to treat the recipient.
• Identification of the other provider and therapy discipline.

When cotreatment is approved, “cotreatment is approved” will be written on the bottom of the PA request.

If cotreatment is approved, two providers of different therapy disciplines can be reimbursed by Wisconsin Medicaid for the same time period. For example, if a recipient is treated by an OT provider and an SLP provider from 1:00 to 2:00, both providers could receive Medicaid reimbursement for one hour. However, if cotreatment is not approved, both the OT provider and the SLP provider would not receive reimbursement for one hour. Instead, each provider could receive reimbursement for 30 minutes.

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