Rule 5160-4-03 | Services provided by a physician assistant.
(A) Definitions.
(1) "Physician assistant" has the same meaning as in Chapter 4730. of the Revised Code.
(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) Coverage. For a covered service performed by a physician assistant who is currently enrolled as an Ohio medicaid provider, payment may be made only if the physician assistant practices under either of the following arrangements:
(1) The physician assistant provides services 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; or
(2) The physician assistant practices in a health care facility and provides services the facility has authorized the physician assistant to perform.
(C) Payment.
(1) For assistant-at-surgery services performed by a physician assistant, payment is twenty-five per cent of the medicaid maximum for the covered primary surgical procedure.
(2) For a covered immunization, injection of medication, or provider-administered pharmaceutical, payment is made in accordance with rule 5160-4-12 of the Administrative Code.
(3) For all other covered services performed by a physician assistant, payment is the lesser of the billing provider's submitted charge or eighty-five per cent of the medicaid maximum.
(4) Payment for services provided by a hospital-employed physician assistant will be made to the hospital.
Last updated January 3, 2022 at 9:48 AM
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