Ohio Administrative Code Search

...(A) General provisions. (1) "Current procedural terminology (CPT)" is a comprehensive listing of medical terms and codes published by the American medical association, www.ama-assn.org, for the uniform designation of diagnostic and therapeutic procedures in surgery, medicine, and the medical specialties. "Healthcare common procedure coding system (HCPCS)" is a numeric and alphanumeric code set ma...

...(A) General provisions. (1) A "not otherwise specified," "unlisted," or "miscellaneous" procedure code should be reported on a claim only if no procedure code is available that identifies the particular service or item provided. (2) No separate payment is made for an immunization, injection, infusion, vaccine, toxoid, or provider-administered pharmaceutical as a medical service if it is provide...

...(A) Chemotherapy has two components: administration of a chemotherapeutic agent and the chemotherapeutic agent itself. The administration of chemotherapy includes the preparation of the chemotherapeutic agent and all therapeutic services and medical supplies provided during treatment. (B) Coverage. (1) Chemotherapy provided in a hospital setting (inpatient hospital, outpatient hospital, emergenc...

...(A) Coverage. (1) In general, payment may be made to an eligible provider for performing a medically necessary surgical procedure on an eligible recipient. The following limitations, however, apply. (a) No separate payment is made to the provider of a surgical service for local infiltration, the administration of general anesthesia or sedation, normal uncomplicated preoperative and postoperative care, or any proced...

...(A) Coverage. (1) In general, payment may be made to an eligible provider for performing a medically necessary surgical procedure on a medicaid-eligible individual. The following limitations, however, apply. (a) No separate payment is made to the provider of a surgical service for local infiltration, the administration of general anesthesia or sedation, normal uncomplicated preoperative and post...

...(A) Payment may be made to an ambulatory surgery center (ASC) in the form of a facility fee only for covered ASC surgical procedures, which are procedures that meet the standards set forth in 42 CFR 416.166 (October 1, 2017). Such procedures are listed on the department's website http://www.medicaid.ohio.gov/provider/feeschedulesandrates. (B) Payment may be made to a physician for performing ...

...(A) Payment may be made to an ambulatory surgery center (ASC) in the form of a facility fee only for covered ASC surgical procedures, which are procedures that meet the standards set forth in 42 CFR 416.166 (October 1, 2017). Such procedures are listed on the department's website https://medicaid.ohio.gov/resources-for-providers/billing/fee-schedule-and-rates/fee-schedule-and-rates. (B) Payment m...

...(A) Coverage. (1) Total (global) procedure. Payment may be made to a practitioner for performing both the professional and technical components of a radiology or imaging procedure if two conditions are met: (a) The technical component was not performed in a hospital setting (i.e., an inpatient hospital, an outpatient hospital, or a hospital emergency department); and (b) The practitioner who submitted the claim ei...

...(A) Coverage. (1) Total (global) procedure. Payment may be made to a practitioner for performing both the professional and technical components of a radiology or imaging procedure if two conditions are met: (a) The technical component was not performed in a hospital setting (i.e., an inpatient hospital, an outpatient hospital, or a hospital emergency department); and (b) The practitioner who su...

...(A) This rule sets forth provisions governing payment for professional, non-institutional dental services. Provisions governing payment for dental services performed as the following service types are set forth in the indicated part of the Administrative Code: (1) Hospital services, Chapter 5160-2; (2) Nursing facility services, Chapter 5160-3; (3) Intermediate care facility services, C...

...(A) This rule sets forth provisions governing payment for professional, non-institutional dental services. Provisions governing payment for dental services performed as the following service types are set forth in : (1) Hospital services, Chapter 5160-2 of the Administrative Code; (2) Nursing facility services, Chapter 5160-3 of the Administrative Code; (3) Intermediate care facility servic...

...(A) This rule sets forth provisions governing payment for professional, non-institutional dental services. Provisions governing payment for dental services performed as the following service types are set forth in the indicated part of the Administrative Code: (1) Hospital services, Chapter 5160-2; (2) Nursing facility services, Chapter 5160-3; (3) Intermediate care facility services, C...

...(A) Definitions. (1) "Eligible provider" has the same meaning as in rule 5160-1-17 of the Administrative Code. (2) "Eye care services" is a collective term for the following services and materials involving the health of the eyes: (a) Vision care services, which include the following procedures: (i) Diagnostic and comprehensive examination; (ii) Testing; (iii) Therapeutic treatme...

...(A) Scope. This rule sets forth general coverage and payment policy for eye care services. Additional provisions for eye care services provided through a medicaid managed care organization are described in Chapter 5160-26 of the Administrative Code. (B) Definitions. (1) "Eligible provider" has the same meaning as in rule 5160-1-17 of the Administrative Code. (2) "Eye care services" is a col...

...(A) For the purpose of this rule the following definitions apply. (1) "Doctor of podiatric medicine" (or "podiatric physician" or "podiatrist") is as described in section 4731.51 of the Revised Code. (a) Doctors of podiatric medicine are deemed to be physicians only in respect to functions they are legally authorized to perform in accordance with section 4731.51 of the Revised Code and rule ...

...(A) Scope. This rule sets forth provisions governing payment for behavioral health services provided by certain licensed professionals in non-institutional settings. (1) Provisions governing payment for behavioral health services as the following service types are set forth in the indicated part of the Administrative Code: (a) Cost-based clinic services, Chapter 5160-28; and (b) Medicaid school pro...

...(A) Scope. This rule sets forth provisions governing payment for professional, non-institutional spinal manipulation and related diagnostic imaging services. (B) Providers. (1) Rendering providers. The following eligible providers may render a service described in this rule: (a) A chiropractor, defined in Chapter 4734. of the Revised Code. (b) A mechanotherapist, defined in Chapter 4731. of th...

...(A) Scope. This rule sets forth provisions governing coverage and payment for professional, non-institutional spinal manipulation and related diagnostic imaging services. (B) Providers. (1) Rendering providers. The following eligible providers may render a service described in this rule: (a) A chiropractor, defined in Chapter 4734. of the Revised Code. (b) A mechanotherapist, defined in Chapter 4731. of the Revis...

...(A) Scope. This rule sets forth provisions governing payment for skilled therapies as non-institutional professional services furnished by skilled therapists and skilled therapist assistants or aides. Provisions governing payment for skilled therapies as the following service types are set forth in the indicated part of the Administrative Code: (1) Hospital services, Chapter 5160-2; (2) Nurs...

...(A) Scope. This rule sets forth provisions governing payment for skilled therapies as non-institutional professional services furnished by skilled therapists and skilled therapist assistants or aides. Provisions governing payment for skilled therapies as the following service types are set forth in the indicated part of the Administrative Code: (1) Hospital services, Chapter 5160-2; (2) Nurs...

...(A) Providers. (1) Rendering providers. The following practitioners, defined in Chapter 4759. of the Revised Code, may enroll in medicaid as eligible providers of dietitian services: (a) A licensed dietitian; and (b) A registered dietitian. (2) Billing ("pay-to") providers. The following eligible providers may receive medicaid payment for submitting a claim for a covered service on behalf ...

...(A) Providers. (1) Rendering providers. The following practitioners, defined in Chapter 4759. of the Revised Code, may enroll in medicaid as eligible providers of dietitian services: (a) A licensed dietitian; and (b) A registered dietitian. (2) Billing ("pay-to") providers. The following eligible providers may receive medicaid payment for submitting a claim for a covered service on behalf of a ...

...(A) Scope and definitions. (1) This rule sets forth provisions governing payment for professional, non-institutional lactation consulting services. (2) "Lactation consultation" is the development and implementation of management strategies for complex problems related to breastfeeding and human lactation. (3) "International Board Certified Lactation Consultant" (IBCLC) is a professional member...

...(A) Definitions applicable to this rule. (1) "Eligible provider" has the same meaning as in rule 5160-1-17 of the Administrative Code. (2) "Lactation consultation" is the development and implementation of management strategies for complex problems related to breastfeeding and human lactation. (3) "International Board-Certified Lactation Consultant (IBCLC)" is a professional member of ...

...(A) Definitions applicable to this rule. (1) "Doula" is an individual listed in the registry specified in section 4723.89 of the Revised Code. (2) "Doula service" is any of the support activities specified in section 4723.89 of the Revised Code. (3) "Independent" and "non-independent," with respect to a doula, have the same meanings as in rule 5160-4-02 of the Administrative Code. (B)...