5101:3-10-16.1 Wheelchair rentals.

(A) Definition

A "Rental Wheelchair" is defined in accordance with paragraph (C) of rule 5101:3-10-16 of the Administrative Code.

(B) Billing

The procedure necessary for billing the Ohio medicaid program for a wheelchair rental is defined in appendix A to rule 5101:3-10-03 of the Administrative Code.

(C) Reimbursement

(1) The reimbursement rate for wheelchair base codes utilizing the following "Healthcare Common Procedure Coding System" (HCPCS) codes in conjunction with the "RR" modifier are as follows:

(a) E1235 reimburses at sixty-five dollars per month.

(b) E1236 reimburses at sixty-five dollars per month.

(c) E1237 reimburses at sixty-five dollars per month.

(d) E1238 reimburses at sixty-five dollars per month.

(e) K0001 reimburses at forty-five dollars per month.

(f) K0002 reimburses at fifty-five dollars per month.

(g) K0003 reimburses at sixty-dollars per month.

(2) The department will reimburse submitted claims at the provider's usual and customary charge or at the maximums listed in this paragraph, whichever is less.

(3) The department will authorize only one rental wheelchair per consumer per month.

(4) Wheelchair rental codes are not to be used for temporary replacement equipment due to repair of consumer's primary transportation equipment.

(5) Wheelchair rental codes are not to be billed in conjunction with any other wheelchair codes referenced in appendix A to rule 5101:3-10-03 of the Administrative Code.

Effective: 04/25/2011
R.C. 119.032 review dates: 01/03/2011 and 04/01/2016
Promulgated Under: 119.03
Statutory Authority: 5111.02
Rule Amplifies: 5111.01 , 5111.02 , 5111.021
Prior Effective Dates: 10/27/05