• 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

Extension of Therapy vs. Spell of Illness

Physical therapy (PT), occupational therapy (OT), and speech and language pathology (SLP) providers may always choose to request extension of therapy services instead of spell of illness (SOI). For example, a provider may request extension of therapy services instead of SOI when treating an acute onset of a condition, such as a stroke. However, Wisconsin Medicaid will not approve a request for SOI when extension of therapy services is necessary.

Physical therapy, OT, and SLP providers are required to request extension of therapy services (instead of SOI) when any of the following are true:

• The onset of the recipient’s condition occurred more than six weeks prior to the request for SOI.
• The combination of the International Classification of Diseases, Ninth Revision, Clinical Modification code for the PT, OT, or SLP services and the true statement from the Prior Authorization/Spell of Illness Attachment, HCF 11039 (fillable PDF, 54 KB), does not allow for SOI approval.
• The recipient’s need for PT, OT, or SLP services has exceeded the maximum allowable treatment days for that SOI.
• The recipient’s condition does not qualify for an SOI. (Certain conditions never qualify for an SOI, such as mental retardation.)

Physical therapy, OT, and SLP providers are encouraged to request extension of therapy services (instead of SOI) when either of the following are true:

• The provider is unsure if the recipient has received, or is currently receiving, PT, OT, or SLP services from another provider for the current SOI.
• The recipient’s need for PT, OT, or SLP services is expected to exceed the maximum allowable treatment days for that SOI.

Refer to Appendix 18 of this handbook to determine which PA attachment is best suited for the services being requested.

Next — Requesting Services for Birth to 3 Participants
Previous — Requesting Spell of Illness, Maximum Allowable Treatment Days, Unused Treatment Days