Ohio Administrative Code Search

...(A) Definitions. (1) "Blood gas study" is the measurement of such characteristics of blood as the partial pressure of oxygen (PO2) or oxygen saturation. The term applies either to pulse oximetry or to an arterial blood gas (ABG) study. (2) "Group I" and "group II" criteria are sets of clinical indicators used to determine the coverage of oxygen without prior authorization. (a) Group I criteria....

...(A) Provider requirement. A provider of custom-made or custom-fitted compression garments must either employ or contract with a certified fitter and must keep documentation of this relationship on file. (B) Coverage. (1) The default certificate of medical necessity (CMN) form is the ODM 01905, "Certificate of Medical Necessity: Compression Garments" (rev. 7/2018). (2) Payment may be made on...

...(A) The default certificate of medical necessity (CMN) form is the ODM 01905, "Certificate of Medical Necessity: Compression Garments" (rev. 7/2024). (B) Payment may be made only for compression garments generating a pressure of at least eighteen millimeters of mercury (mm Hg). (C) For a gradient compression garment, the provider specifies at least one clinical indication such as but not limited...

...(A) Definitions. (1) "Accessories" is a collective term that encompasses but is not necessarily limited to the following items: (a) Adapters; (b) Clips; (c) Additional connecting cable for lead wires; (d) Carrying pouches; and (e) Covers. (2) "Supplies" is a collective term that encompasses but is not necessarily limited to the following items: (a) Electrodes of any type; (b) Lead wires; (c)...

...(A) Definitions. (1) "Accessories" is a collective term that encompasses but is not necessarily limited to the following items: (a) Adapters; (b) Clips; (c) Additional connecting cable for lead wires; (d) Carrying pouches; and (e) Covers. (2) "Supplies" is a collective term that encompasses but is not necessarily limited to the following items: (a) Electrodes of any type; (b) Lead wires; (c) Con...

...(A) Definitions and explanations. (1) "Basic equipment package" is the following standard set of parts and accessories that come with a wheelchair at the time of purchase: (a) A sling or solid seat with back, a captain's chair, or a stadium-style seat; (b) Standard casters or wheels with tires; (c) Standard armrests; (d) Standard front rigging, such as non-elevating legrests with footrests or...

...(A) Payment may be made directly to a provider for a pneumatic compression device or a related accessory only if the equipment and supplies are used to treat either lymphedema in the extremities or chronic venous insufficiency (CVI) with venous stasis ulcers. Accessories used for pneumatic compression of the chest or trunk are not covered. Before prescribing a pneumatic compression device, a pract...

...(A) Payment may be made directly to a provider for a pneumatic compressor or a related appliance or accessory only if the following conditions are satisfied: (1) The equipment is used to treat either lymphedema in the extremities or chronic venous insufficiency (CVI) with venous stasis ulcers; and (2) The prescribing practitioner has determined either that there was no significant improvement or...

...(A) Definitions and explanations. (1) "Group 1," "group 2," and "group 3" are classes of pressure-reducing support surface. (a) Group 1 surfaces are generally non-powered pads or overlays that are designed to be placed on top of a hospital bed or standard mattress. They achieve their effect through the application of, for example, a gel layer, air pressure, natural lamb's wool, or synthetic ...

...(A) Definitions and explanations. (1) "Group 1," "group 2," and "group 3" are classes of pressure-reducing support surface. (a) Group 1 surfaces are generally non-powered pads or overlays that are designed to be placed on top of a hospital bed or standard mattress. They achieve their effect through the application of, for example, a gel layer, air pressure, natural lamb's wool, or synthetic ...

...(A) Definition. "Apnea-hypopnea index (AHI)" is the mean number of episodes of apnea or hypopnea per hour recorded over a period of at least two hours without the use of a positive airway pressure device, reported by polysomnogram. Extrapolation or projection of the AHI is not permitted. (B) Coverage. (1) The default certificate of medical necessity (CMN) form is the ODM 01903, "Certificate ...

...(A) Definition. "Apnea-hypopnea index (AHI)" is the mean number of episodes of apnea or hypopnea per hour recorded over a period of at least two hours without the use of a positive airway pressure device, reported by polysomnogram. Extrapolation or projection of the AHI is not permitted. (B) Coverage. (1) The default certificate of medical necessity (CMN) form is the ODM 01903, "Certificate ...

...(A) Coverage. (1) The default certificate of medical necessity (CMN) is the ODM 02912, "Certificate of Medical Necessity: Incontinence Items" (rev. 7/2018). The CMN must include the following elements: (a) An indication that the individual is at least thirty-six months of age; (b) The applicable diagnosis of the specific disease, injury, developmental delay, or developmental disability causing ...

...(A) Coverage. (1) Payment for quantities of incontinence garments or incontinence supplies that exceed the indicated limit is subject to prior authorization (PA). The default certificate of medical necessity (CMN) form is the ODM 02912, "Certificate of Medical Necessity: Incontinence Items" (rev. 7/2024). The CMN includes the following elements: (a) An indication that the individual is at least ...

...(A) Condition of provider participation. A provider of in-home use ventilators needs to have available a licensed respiratory care professional (LRCP) twenty-four hours a day to provide respiratory care, technical support, and clinical ventilator services and to perform emergency servicing of equipment on two-hour notice. (B) Coverage. (1) Separate payment may be made for a ventilator furnished ...

...(A) Coverage. (1) Any pulse oximeter for which payment is made must meet the following criteria: (a) It is correctly calibrated, preset, and sealed such that its settings cannot be adjusted by the average user; and (b) It is capable either of converting data (e.g., number of sampling hours, oxygen saturation level, aggregated results) directly to electronic or printed form or of recording and stori...

...(A) Coverage. (1) Payment may be made only for a pulse oximeter that meets the following criteria: (a) It is correctly calibrated, preset, and sealed such that its settings cannot be adjusted by the average user; and (b) It is capable either of converting data (e.g., number of sampling hours, oxygen saturation level, aggregated results) directly to electronic or printed form or of recording and sto...

...(A) Coverage. (1) Separate payment may be made for a speech-generating device (SGD) furnished to a resident of a long-term care facility (LTCF). (2) The default certificate of medical necessity (CMN) form is the ODM 02924, "Certificate of Medical Necessity: Speech-Generating Devices" (rev. 7/2018). The CMN must include the following elements: (a) A formal, written report of a face-to-face evalu...

...(A) Coverage. (1) Separate payment may be made for a speech-generating device (SGD) furnished to a resident of a long-term care facility (LTCF). (2) The default certificate of medical necessity (CMN) form is the ODM 02924, "Certificate of Medical Necessity: Speech-Generating Devices" (rev. 7/2018). The CMN includes the following elements: (a) A formal, written report of a face-to-face evaluatio...

...(A) Definitions and explanations. (1) "Multiple-user lactation pump" is a lactation pump that is safe for use by multiple individuals; it comes with a separate set of accessories (e.g., breast shields, tubing) for each individual, which reduces the risk of contamination. Such a pump is sometimes referred to as "hospital-grade," but this term is not recognized by the United States food and dru...

...(A) Coverage. (1) Enteral and parenteral nutrition. (a) The default certificate of medical necessity (CMN) form is the ODM 01907, "Certificate of Medical Necessity: Enteral and Parenteral Nutrition" (rev. 7/2018). The CMN must include the following information: (i) Attestation to one of the following statements: (a) The individual is able to ingest food but cannot derive sufficient ene...

...(A) Coverage. (1) Enteral and parenteral nutrition. (a) The default certificate of medical necessity (CMN) form is the ODM 01907, "Certificate of Medical Necessity: Enteral and Parenteral Nutrition" (rev. 7/2024). The CMN includes the following information: (i) Attestation to one of the following statements: (a) The individual is able to ingest food but cannot derive sufficient energy ...

...(A) Coverage. (1) Payment may be made for the purchase only of a noninvasive osteogenesis stimulator. (2) The default certificate of medical necessity (CMN) form is the ODM 07134, "Certificate of Medical Necessity: Osteogenesis Stimulators" (rev. 7/2018). The CMN must include an attestation that appropriate coverage criteria are met. (3) Payment may be made for a spinal electrical osteogene...

...(A) Coverage. (1) Payment may be made for the purchase only of a noninvasive osteogenesis stimulator. (2) The default certificate of medical necessity (CMN) form is the ODM 07134, "Certificate of Medical Necessity: Osteogenesis Stimulators" (rev. 7/2024). The CMN includes an attestation that appropriate coverage criteria are met. (3) Payment may be made for a spinal electrical osteogenesis ...

...(A) Definitions. (1) "Sensor-augmented insulin pump system" is an insulin infusion pump equipped with a continuous glucose monitoring (CGM) sensor. The pump uses the glucose readings taken by the CGM sensor to modify the amount of insulin infused. (2) "Insulin pump," for purposes of this rule, is a collective term encompassing a portable external insulin infusion pump and a sensor-augmented insu...