5101:3-8-02 Covered physical therapy services and limitations.

(A) Definitions.

Additional definitions are described in Chapter 5101:3-34 of the Administrative Code.

(1) "Direct supervision" or "directly supervised" means that the physical therapist must be present throughout the time the physical therapist assistant is providing the service and immediately available to provide assistance and direction throughout the time the physical therapist assistant is performing services.

(B) Medicaid eligible provider of physical therapy services.

(1) Physical therapy services described in this rule may be billed by the following limited practitioners who are currently licensed and working within the scope of their practices as defined by state law and have executed the standard Ohio medicaid provider agreement:

(a) Physical therapists in independent practice as set forth in rule 5101:3-8-01 of the Administrative Code and licensed under Chapter 4755. of the Revised Code; and

(b) Mechanotherapists as set forth in rule 5101:3-8-01 of the Administrative Code and licensed under Chapter 4731. of the Revised Code.

(2) Other independently practicing providers authorized to be reimbursed by the department for physical therapy are described in Chapter 3-34 of the Administrative Code.

(3) Physical therapy services provided in a school, hospital, or long term care facility must be billed by the school, hospital, or long term care facility in which the services were provided.

(C) Coverage and limitations.

Medicaid coverage and limitations of physical therapy services are described in Chapter 5101:3-34 of the Administrative Code.

(1) Modality guidelines.

(a) Supervised modalities must have direct (one-on-one) provider to consumer contact. The provider must be licensed to provide the modality and must be directly supervised by a medicaid-authorized prescriber or therapist.

(b) The following modalities are considered part of the associated therapy procedure or medical encounter and are not separately reimbursable:

(i) Electrical stimulation-unattended; and

(ii) Iontophoresis therapy.

(c) Certain modalities are considered part of an associated physical therapy procedure or medical encounter and are not separately reimbursable.

(D) Provider claims, billing, payment, and reimbursement are addressed in Chapters 5101:3-1, 5101:3-2, and 5101:3-3 of the Administrative Code.

Replaces: 5101:3-8-02

Effective: 01/01/2008
R.C. 119.032 review dates: 01/01/2013
Promulgated Under: 119.03
Statutory Authority: 5111.02
Rule Amplifies: 5111.01 , 5111.02 , 5111.021
Prior Effective Dates: 4/7/77, 9/19/77, 12/21/77, 12/30/77, 7/1/02