5160-4-03 Physician assistants.

(A) Definitions.

(1) "Physician assistant" means an individual who is licensed under Chapter 4730.of the Revised Code to provide services as a physician assistant to patients under the supervision, control, and direction of one or more physicians.

(2) "Physician" has the same meaning as in section 4730.01 of the Revised Code.

(3) "Health care facility" has the same meaning as in section 4730.01 of the Revised Code.

(4) "Service" has the same meaning as in section 4730.01 of the Revised Code.

(B) Eligible providers.

To receive medicaid payment, a physician assistant must hold a license to practice as a physician assistant issued under Chapter 4730. of the Revised Code and be enrolled as an Ohio medicaid provider.

(C) Coverage and limitations.

(1) Payment may be made for services rendered by a physician assistant only when the following conditions are met:

(a) The physician assistant is practicing under the supervision, control, and direction of a physician with whom the physician assistant has entered into a supervision agreement under section 4730.19 of the Revised Code.

(b) The physician assistant is practicing in accordance with the supervision agreement entered into with the physician who is responsible for supervising the physician assistant.

(2) When a physician assistant provides services in a health care facility, payment may be made for services the facility authorizes the physician assistant to provide for the facility.

(D) Claim payment.

(1) The department will pay physician assistants the lesser of the billed charge or eighty-five per cent of the medicaid maximum for covered services rendered by physician assistants.

(2) The department will pay for assistant-at-surgery services performed by physician assistants at the lesser of the billed charge or twenty-five percent of the medicaid maximum for the covered primary surgical procedure.

(3) Payment for services provided by a hospital-employed physician assistant will be made to the hospital.

Replaces: 5160-4-03

Cite as Ohio Admin. Code 5160-4-03

Effective: 1/1/2017
Five Year Review (FYR) Dates: 12/31/2021
Promulgated Under: 119.03
Statutory Authority: 5164.02, 5164.301
Rule Amplifies: 5164.02, 5164.301 , 5164.70
Prior Effective Dates: 9/1/89, 4/1/92 (Emer), 7/1/92, 4/1/93, 11/1/01, 10/1/03, 2/16/09, 7/1/2012