Section DHS 107.15 - Chiropractic services(1) DEFINITION. In this section, "spell of illness" means a condition characterized by the onset of a spinal subluxation. "Subluxation" means the alteration of the normal dynamics, anatomical or physiological relationships of contiguous articular structures. A subluxation may have biomechanical, pathophysiological, clinical, radiologic and other manifestations.(2) COVERED SERVICES. Chiropractic services covered by MA are manual manipulations of the spine used to treat a subluxation. These services shall be performed by a chiropractor certified pursuant to s. DHS 105.26.(3) SERVICES REQUIRING PRIOR AUTHORIZATION. (a) Requirement. 1. Prior authorization is required for services beyond the initial visit and 20 spinal manipulations per spell of illness. The prior authorization request shall include a justification of why the condition is chronic and why it warrants the scope of service being requested.2. Prior authorization is required for spinal supports which have been prescribed by a physician or chiropractor if the purchase or rental price of a support is over $75. Rental costs under $75 shall be paid for one month without prior approval.(b) Conditions justifying spell of illness designation. The following conditions may justify designation of a new spell of illness if treatment for the condition is medically necessary: 1. An acute onset of a new spinal subluxation;2. An acute onset of an aggravation of pre-existing spinal subluxation by injury; or3. An acute onset of a change in pre-existing spinal subluxation based on objective findings.(c) Onset and termination of spell of illness. The spell of illness begins with the first day of treatment or evaluation following the onset of a condition under par. (b) and ends when the recipient improves so that treatment by a chiropractor for the condition causing the spell of illness is no longer medically necessary, or after 20 spinal manipulations, whichever comes first. (d) Documentation. The chiropractor shall document the spell of illness in the patient plan of care.(e) Non-transferability of treatment days. Unused treatment days from one spell of illness shall not be carried over into a new spell of illness.(f) Other coverage. Treatment days covered by medicare or other third-party insurance shall be included in computing the 20 spinal manipulation per spell of illness total.(g) Department expertise. The department may have on its staff qualified chiropractors to develop prior authorization criteria and perform other consultative activities.(4) OTHER LIMITATIONS. (a) An x-ray or set of x-rays, such as anterior-posterior and lateral, is a covered service only for an initial visit if the x-ray is performed either in the course of diagnosing a spinal subluxation or in the course of verifying symptoms of other medical conditions beyond the scope of chiropractic.(b) A diagnostic urinalysis is a covered service only for an initial office visit when related to the diagnosis of a spinal subluxation, or when verifying a symptomatic condition beyond the scope of chiropractic.(c) The billing for an initial office visit shall clearly describe all procedures performed to ensure accurate reimbursement.(5) NON-COVERED SERVICES. Consultations between providers regarding a diagnosis or treatment are not covered services.Wis. Admin. Code Department of Health Services DHS 107.15
Cr. Register, February, 1986, No. 362, eff. 3-1-86; correction in (2) made under s. 13.92(4) (b) 7, Stats., Register December 2008 No. 636. For more information on non-covered services, see s. DHS 107.03.