DHS 107.24(4)(j)(j) The cost of mailing or delivery, such as shipping and handling charges and fees, of diagnostic tools or equipment needed to assess, diagnose, repair or setup medical supplies, hearing aids, cochlear implants, or other equipment cannot be billed to the recipient.
DHS 107.24(5)(5)Non-covered services. The following services are not covered services:
DHS 107.24(5)(a)(a) Foot orthoses or orthopedic or corrective shoes for the following conditions:
DHS 107.24(5)(a)1.1. Flattened arches, regardless of the underlying pathology;
DHS 107.24(5)(a)2.2. Incomplete dislocation or subluxation metatarsalgia with no associated deformities;
DHS 107.24(5)(a)3.3. Arthritis with no associated deformities; and
DHS 107.24(5)(a)4.4. Hypoallergenic conditions;
DHS 107.24(5)(b)(b) Services denied by both Medicare and MA for lack of medical necessity.
DHS 107.24(5)(c)(c) Items which are not primarily medical in nature, such as dehumidifiers and air conditioners;
DHS 107.24(5)(d)(d) Items which are not appropriate for home usage, such as oscillating beds;
DHS 107.24(5)(e)(e) Items which are not generally accepted by the medical profession as being therapeutically effective, such as a heat and massage foam cushion pad;
DHS 107.24(5)(f)(f) Items which are for comfort and convenience, such as cushion lift power seats or elevators, or luxury features which do not contribute to the improvement of the recipient’s medical condition;
DHS 107.24(5)(g)(g) Repair, maintenance or modification of rented durable medical equipment;
DHS 107.24(5)(h)(h) Delivery or set-up charges for equipment as a separate service;
DHS 107.24(5)(i)(i) Fitting, adapting, adjusting or modifying a prosthetic or orthotic device or corrective or orthopedic shoes as a separate service;
DHS 107.24(5)(j)(j) All repairs of a hearing aid or other assistive listening device performed by a dealer within 12 months after the purchase of the hearing aid or other assistive listening device. These are included in the purchase payment and are not separately reimbursable;
DHS 107.24(5)(k)(k) Hearing aid or other assistive listening device batteries which are provided in excess of the guidelines enumerated in the MA speech and hearing provider handbook;
DHS 107.24(5)(L)(L) Items that are provided for the purpose of enhancing the prospects of fertility in males or females;
DHS 107.24(5)(m)(m) Impotence devices, including but not limited to penile prostheses;
DHS 107.24(5)(n)(n) Testicular prosthesis;
DHS 107.24(5)(o)(o) Food; and
DHS 107.24(5)(p)(p) Infant formula and enteral nutritional products except as allowed under s. DHS 107.10 (2) (c).
DHS 107.24 HistoryHistory: Cr. Register, February, 1986, No. 362, eff. 3-1-86; emerg. r. and recr. (3) (h) 1. and 2., eff. 7-1-89; am. (2) (d) 6., (3) (e), (h) 4., (4) (c) 2., (5) (j) and (k), r. and recr. (3) (h) (intro.), 1. and 2. and (4) (g), cr. (4) (h), Register, May, 1990, No. 413, eff. 6-1-90; r. and recr. (4) (a), Register, September, 1991, No. 429, eff. 10-1-91; am. (5) (j) to (k), cr. (5) (L) to (p), Register, January, 1997, No. 493, eff. 2-1-97; correction in (4) (b) made under s. 13.93 (2m) (b) 7., Stats., Register February 2002 No. 554; CR 03-033: am. (2) (a), (3) (h) 1. (intro.), 2., and (5) (j) Register December 2003 No. 576, eff. 1-1-04; CR 20-012: renum. (1) to (1) (intro.) and am., cr. (1) (b), am. (2) (a), cr. (2) (a) 2., am. (2) (c) 1., 4., 6., cr. (2) (c) 9., am. (3) (intro.), (a) to (g), (h) 1. to 3., cr. (3) (i), (j), (4) (i), am. (5) (b) Register October 2021 No. 790, eff. 11-1-21; correction in (3) (g) made under s. 35.17, Stats., Register October 2021 No. 790; CR 20-039: am. (2) (c) 1., 4. to 6. Register October 2021 No. 790, eff. 11-1-21; merger of (2) (c) 1., 4., 6. treatments by CR 20-012 and CR 20-039 made under s. 13.92 (4) (bm), Stats., Register October 2021 No. 790; correction in (2) (a) 1. made under s. 35.17, Stats., Register December 2021, No. 792; CR 22-043: Register May 2023 No. 809, eff. 6-1-23; CR 23-005: am. (4) (c) 1., renum. (4) (c) 2. to (4) (c) 2. (intro.) and am., cr. (4) (c) 2. a. to c., r. (4) (c) 3. Register April 2024 No. 820, eff. 5-1-24; merger of (2) (c) 1., 4., 6. treatments by CR 20-012 and CR 23-046 and merger of (2) (c) 1., 4. to 6. treatments by CR 20-012, CR 20-039, and CR 23-046 made under s. 13.92 (4) (bm), Stats., Register April 2024 No. 820.
DHS 107.25DHS 107.25Diagnostic testing services.
DHS 107.25(1)(1)Covered services. Professional and technical diagnostic services covered by MA are laboratory services provided by a certified physician or under the physician’s supervision, or prescribed by a physician and provided by an independent certified laboratory, and x-ray services prescribed by a physician and provided by or under the general supervision of a certified physician.
DHS 107.25(2)(2)Other limitations.
DHS 107.25(2)(a)(a) All diagnostic services shall be prescribed or ordered by a physician or dentist.
DHS 107.25(2)(b)(b) Laboratory tests performed which are outside the laboratory’s certified areas are not covered.
DHS 107.25(2)(c)(c) Portable x-ray services are covered only for recipients who reside in nursing homes and only when provided in a nursing home.