Ohio Administrative Code Search

...practitioner enrolled as a medicaid provider requests the consultation. For purposes of this rule, a medical visit initiated by someone other than a licensed medical practitioner (e.g., a patient, a family member, a teacher, a social worker) is not a consultation. (b) The request for a consultation, the need for a consultation, the consultant's opinion, and any services that were ordered or perfo...

...tion, infusion, vaccine, toxoid, or provider-administered pharmaceutical as a medical service if it is provided in a hospital setting (inpatient hospital, outpatient hospital, or hospital emergency department). (4) A provider-administered pharmaceutical reported on a claim submitted in accordance with Chapter 5160-9 of the Administrative Code is regarded as a pharmacy service rather than a ph...

...njection, infusion, vaccine, toxoid, or provider-administered pharmaceutical as a medical service if it is provided in a hospital setting (inpatient hospital, outpatient hospital, or hospital emergency department). (3) A provider-administered pharmaceutical reported on a claim submitted in accordance with Chapter 5160-9 of the Administrative Code is regarded as a pharmacy service rather than a ...

...llergen antigen may be made only if the provider prepares the antigen for injection by another entity. (e) The date of service is the date on which the first dose is administered or the date on which the vial is dispensed for future use. (f) Immunotherapy is not considered to be medically necessary for an allergic reaction to common environmental factors (such as dust, house plants, or natural f...

...ral, 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 procedure that is performed inci...

... 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 postoperative care, or any pro...

...ebsite http://www.medicaid.ohio.gov/provider/feeschedulesandrates. (B) Payment may be made to a physician for performing a covered surgical procedure in an ASC even if the surgery is not itself a covered ASC surgical procedure. (C) Payment may be made to a physician for performing the professional component of a covered laboratory, radiologic, diagnostic, or therapeutic service in an ASC only if...

...e component performed by a non-hospital provider, payment is the lesser of the submitted charge or the product of the following two figures: (a) The maximum payment amount listed in appendix DD to rule 5160-1-60 of the Administrative Code; and (b) The relevant percentage indicated by the 'prof/tech split' entry listed in appendix DD to rule 5160-1-60 of the Administrative Code. (2) If more than one advanced imagin...

...mponent performed by a non-hospital provider, payment is the lesser of the submitted charge or the product of the following two figures: (a) The maximum payment amount listed in appendix DD to rule 5160-1-60 of the Administrative Code; and (b) The relevant percentage indicated by the 'prof/tech split' entry listed in appendix DD to rule 5160-1-60 of the Administrative Code (or one hundred per ce...

...lth problems and does not have a dental provider, referral to a dentist or to the county department of job and family services. (C) Payment for the application of fluoride varnish is made separately from payment for a well child visit or a sick child visit.

...the urban areas within the county. (C) Providers of dental services. (1) Rendering providers. The following eligible medicaid providers may render a dental service: (a) A dentist practicing in Ohio; (b) A dental resident acting within their licensure and scope of practice; or (c) A dentist practicing in a state other than Ohio who meets the requirements established by the dental examining board...

...the urban areas within the county. (C) Providers of dental services. (1) Rendering providers. The following eligible medicaid providers may render a dental service: (a) A dentist practicing in Ohio; (b) A dental resident acting within their licensure and scope of practice; or (c) A dentist practicing in a state other than Ohio who meets the requirements established by the dental examining board...

...the urban areas within the county. (C) Providers of dental services. (1) Rendering providers. The following eligible medicaid providers may render a dental service: (a) A dentist practicing in Ohio; (b) A dental resident acting within their licensure and scope of practice; or (c) A dentist practicing in a state other than Ohio who meets the requirements established by the dental examining board...

...(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...

...e. (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 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 tre...

...h services are paid directly to the provider of services and not through the nursing facility per diem rate. (B) Definitions for the purposes of this rule. (1) "Behavioral health service" is a service or procedure that is performed for the diagnosis and treatment of mental, behavioral, substance use, or emotional disorders by a licensed professional or under the supervision of a licensed ...

...lated 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 Revised Code. (2) Billing ("pay-to") providers. The following eligible providers may receive medicaid payment for su...

... services rendered by the following providers: (a) Service-based ambulatory health care clinics, Chapter 5160-13; or (b) Cost-based clinics, Chapter 5160-28; (7) Medicaid school program services, Chapter 5160-35; and (8) Intermediate care facility services, Chapter 5123:2-7. (B) Definitions. (1) "Audiologist" is a person who holds a valid license as an audiologist under Chapter 4753. of the ...

... Services rendered by the following providers: (a) Ambulatory health care clinics, Chapter 5160-13; or (b) Federally qualified health centers (FQHCs) or rural health clinics (RHCs), Chapter 5160-28; (7) Medicaid school program services, Chapter 5160-35; and (8) Intermediate care facility services, Chapter 5123:2-7. (B) Definitions. (1) "Audiologist" is a person who holds a valid license ...

...(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 ...

...g experience and environment. (B) Providers. (1) Rendering providers. The following eligible providers may render a lactation consultation service: (a) A physician. (b) A physician assistant. (c) An advanced practice registered nurse. (2) Billing ("pay-to") providers. The following eligible providers may receive medicaid payment for lactation consultation services on behalf of a rendering ...

...le 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 the healthcare team wh...

...of the Revised Code. (2) "Eligible provider" has the same meaning as in rule 5160-1-17 of the Administrative Code. (B) Providers. (1) Rendering provider. The following eligible providers may render a covered acupuncture service: (a) An acupuncturist recognized under section 4762.02 of the Revised Code; or (b) An individual practitioner, other than an acupuncturist, who may render acupunct...

...1 of the Administrative Code. (B) Providers. An individual pharmacist may enroll in medicaid as a pharmacist provider. (C) Coverage. (1) Payment may be made only for a pharmacist service for which the following criteria are met: (a) The service is within a pharmacist's scope of practice; (b) The service is medically necessary in accordance with rule 5160-1-01 of the Administrative Code;...