5101:3-4-26 Covered physical medicine and rehabilitation services.

(A) Physical medicine and rehabilitation services described in Chapter 5101:3-34 of the Administrative Code are covered in the office setting of a physician.

(B) Physical medicine and rehabilitation services may be billed by eligible providers of physician services as defined in rule 5101:3-4-01 of the Administrative Code which have executed the standard Ohio medicaid provider agreement.

(C) The provisions in Chapter 5101:3-34 of the Administrative Code apply to physical medicine and rehabilitation services except the terms "physical or occupational therapy" shall be replaced by the term "physical medicine" and "physical or occupational therapist" shall be replaced by the term "physician."

(D) Eligible providers of physician services may be reimbursed for covered physical medicine and rehabilitation services performed by a physician, by a licensed physical or occupational therapist employed by or under contract with the physician, or by licensed individuals who are under the direct supervision of the physician in accordance with rule 5101: 3-4-02 of the Administrative Code.

(E) The department also covers physical medicine and rehabilitation services prescribed by a physician, but personally performed by a self-employed physical or occupational therapist, physical or occupational therapist assistant under the direct supervision of a physical or occupational therapist, physical or occupational therapy group practice, or mechanotherapist eligible to provide services under medicaid. In this case, the physician may be reimbursed for any direct medical services he provides (e.g., physical evaluation and determination of the plan of treatment), but may not be reimbursed for the services provided by a self-employed physical therapist, occupational therapist, physical therapy group, occupational therapy group, or mechanotherapist who may bill for these services directly.

(F) Services that do not meet the provisions outlined in Chapter 5101:3-34 of the Administrative Code and do not require the professional skills of a physician to perform or supervise the services are considered non-covered services.

Effective: 01/01/2008
R.C. 119.032 review dates: 10/16/2007 and 01/01/2013
Promulgated Under: 119.03
Statutory Authority: 5111.02
Rule Amplifies: 5111.01 , 5111.02 , 5111.021 , 5111.029
Prior Effective Dates: 10/1/83 (Emer.), 12/29/83, 1/1/86, 5/4/86, 6/16/88, 1/13/89 (Emer.), 9/1/89, 12/30/94 (Emer.), 3/30/95, 7/1/02