5160-4-17 Gastroenterology, otorhinolaryngology, endocrinology, neurology, photodynamic therapy and special dermatology services.

(A) The appropriate use of professional and technical modifiers and relevant place of service restrictions for gastroenterology, otorhinolaryngology, endocrinology, neurology, photodynamic therapy, and special dermatology procedures are set forth in rule 5101:3-4-11 of the Administrative Code.

(B) Otorhinolaryngologic services.

(1) The following speech and hearing services are professional services and may not be reimbursed in addition to an evaluation and management service:

(a) Otorhinolaryngologic examination under general anesthesia;

(b) Binocular microscopy performed as a separate procedure;

(c) Evaluation of speech, language, voice, communication, auditory processing, and/or aural rehabilitation status;

(d) Individual treatment of speech, language, voice, communication, and/or auditory processing disorder, including aural rehabilitation;

(e) Group treatment of speech, language, voice, communication, and/or auditory processing disorder, including aural rehabilitation;

(f) Nasopharyngoscopy performed as a separate procedure;

(g) Nasal function studies;

(h) Facial nerve function studies;

(i) Laryngeal function studies;

(j) Tympanometry and reflex threshold measurements; and

(k) Treatment of swallowing dysfunction and/or oral function for feeding.

(2) Procedure codes 92613, 92615 and 92617 are bundled into the related surgical procedure and are not separately reimbursable.

(3) When audiologic procedures are provided in a hospital setting, the services are considered hospital services and reimbursement will be made only to the hospital.

(4) Professional services associated with audiologic function tests are included either in the evaluation and management codes or the procedures listed in paragraph (B)(1) of this rule.

(5) Hearing aid examination and selection services are covered as part of the dispensation of the hearing aid in accordance with Chapter 5101:3-10 of the Administrative Code and will not be reimbursed as a separate procedure.

(C) Special dermatological procedures. Physician services associated with 96900, 96910, 96911, and 96912 are considered a part of the evaluation and management service.

Replaces: 5101:3-4-17

Effective: 12/06/2010
R.C. 119.032 review dates: 12/01/2015
Promulgated Under: 119.03
Statutory Authority: 5111.02
Rule Amplifies: 5111.01, 5111.02, 5111.021
Prior Effective Dates: 9/1/89, 5/25/91, 4/1/92 (Emer), 7/1/92, 12/30/93
(Emer), 3/31/94, 12/30/94 (Emer), 3/30/95, 12/29/95 (Emer), 3/21/96, 12/31/01 (Emer), 3/29/02, 7/1/03, 1/2/04 (Emer), 4/1/04, 12/30/04 (Emer), 3/20/05, 12/30/05 (Emer), 3/27/06, 12/29/06 (Emer), 3/29/07, 12/31/07 (Emer), 3/30/08, 12/31/08 (Emer), 3/31/09