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Fee Schedules and Rates

Ambulatory Surgical Centers

ASC Rates – ASCs are paid a facility fee for certain procedure codes as noted in the 'Current Surgical Group' column in the ASC section of the 'Medicine, Surgery, Radiology and Imaging, and Additional Procedures (Non-Institutional Services)' schedule.

Anesthesia Services

This table (PDF) lists the current payment amounts for anesthesia administration. It reflects the policy set forth in Ohio Administrative Code rule 5160-4-21.

CPT and HCPCS Level II Procedure Code Changes

CPT and HCPCS level II procedure codes that were added or discontinued as of January 1, 2017

CPT and HCPCS level II procedure codes that were added or discontinued as of January 1, 2016

CPT and HCPCS level II procedure codes that were added or discontinued as of January 1, 2015

Durable Medical Equipment

Face-to-face encounter. This table (XLS) lists DME items, medical supplies, orthotics, and prosthetics for which a prescription must originate as a result of a face-to-face encounter between a prescriber and an individual. The interval between the encounter and the prescription must not be more than 180 days.

Right/left side. This table (XLS) lists items that are differentiated for use on either the right side or the left side of the body. Either modifier RT or modifier LT is reported on the claim; both modifiers are reported when an item is dispensed bilaterally on the same date of service.

DME and supplies. This table (PDF) lists the current maximum payment amounts for many durable medical equipment items and supplies. It reflects the policy set forth in Ohio Administrative Code rule 5160-10-03.

Oxygen. This table (PDF) lists the current maximum payment amounts for oxygen. It reflects the policy set forth in Ohio Administrative Code rule 5160-10-13.

Wheelchairs. This table (XLS) lists the current maximum payment amounts for wheelchairs, parts, accessories, and related services. It reflects the policy set forth in Ohio Administrative Code rule 5160-10-16.

O & P. This table (PDF) lists the current maximum payment amounts for orthotic devices, prostheses, and related services. It reflects the policy set forth in Ohio Administrative Code rule 5160-10-20.

Freestanding Birthing Centers

These providers are reimbursed for specific procedure codes as detailed in the Appendix of Ohio Administrative Code Rule 5101:3-18-01.

Home and Community-Based Services Waiver Fee Schedule

Home Health Rates

Hospice Rates

  • Hospice Rates FFY 2017 – October 1, 2016 – September 30, 2017 for Providers that Comply with Quality Data Reporting Requirements
  • Hospice Rates FFY 2017 – October 1, 2016 – September 30, 2017 for Providers that Failed to Comply with Quality Reporting Requirements
  • Hospice Rates FFY 2016 – October 1, 2015 – September 30, 2016 for Providers that Comply with Quality Data Reporting Requirements
  • Hospice Rates FFY 2016 – October 1, 2015 – September 30, 2016 for Providers that Failed to Comply with Quality Reporting Requirements
  • Hospice Rates FFY 2015 – October 1, 2014 – September 30, 2015 for Providers that Comply with Quality Data Reporting Requirements
  • Hospice Rates FFY 2015 – October 1, 2014 – September 30, 2015 for Providers that Failed to Comply with Quality Reporting Requirements
  • Hospice Rates FFY 2014 – October 1, 2013 – September 30, 2014 for Providers that Have Submitted Required Quality Data to Medicare
  • Hospice Rates FFY 2014 – October 1, 2013 – September 30, 2014 for Providers that Have NOT Submitted Required Quality Data to Medicare
  • Hospice Rates FFY 2013 – October 1, 2012 – September 30, 2013

Inpatient Hospital Services

Laboratory Services

This table (PDF) (XLSX) lists the current coverage and maximum payment amounts for clinical diagnostic procedures, pathology procedures, and related services.  It reflects the policy set forth in Chapter 5160-11 of the Ohio Administrative Code.

Medicaid Fee Schedule for Community Behavioral Health Providers (OhioMHAS Administered)

Medicine, Surgery, Radiology and Imaging, and Additional Procedures (Non-Institutional Services)

This schedule (PDF) - (XLSX) applies to most non-institutional fee-for-service providers.  It is published as Appendix DD to rule 5160-1-60 of the Ohio Administrative Code.

Outpatient Hospital Services

The Outpatient Fee Schedules are several Appendices of Ohio Administrative Code Rule 5160-2-21.

  • Addendum (PDF) - (XLS) CPT Code Changes Effective 1/1/2017. This Addendum should be used in tandem with the 10/1/2016 appendices to determine coverage of procedure codes for dates of service on or after 1/1/2017.

The following fee schedules are applicable for dates of service on or after 10/1/2016:

  • Appendix A (PDF) - (XLS) Local Level Codes & Modifiers.
  • Appendix B (PDF) - (XLS) Revenue Center Codes Requiring CPT or HCPCS Coding.
  • Appendix C (PDF) - (XLS) Ambulatory Surgery Fee Schedule.
  • Appendix D (PDF) - (XLS) Clinic Facility Fee Schedule.
  • Appendix E (PDF) - (XLS) Emergency Room Fee Schedule.
  • Appendix F (PDF) - (XLS) Ancillary Fee Schedule.
  • Appendix G (PDF) - (XLS) Outpatient Hospital Radiology Fee Schedule.
  • Appendix H Outpatient Hospital Laboratory Fee Schedule has been rescinded. Please refer to the Laboratory Services Fee Schedule for coverage and reimbursement rates of laboratory codes. Please refer to Appendix DD for reimbursement rate of CPT code 36416 (capillary blood draw).
    • Appendix H (PDF) - (XLS) Outpatient Hospital Laboratory Fee Schedule (for dates of service on or before 12/31/2015).
  • Appendix I (PDF) - (XLS) HCPCS Q-Codes Covered in an Outpatient Hospital Setting.


The following fee schedules are applicable for dates of service on or after 1/1/2016:

  • Addendum (PDF) - (XLS) CPT Code Changes Effective January 1, 2016.
  • Appendix A (PDF) - (XLS) Local Level Codes & Modifiers.
  • Appendix B (PDF) - (XLS) Revenue Center Codes Requiring CPT or HCPCS Coding.
  • Appendix C (PDF) - (XLS) Ambulatory Surgery Fee Schedule.
  • Appendix D (PDF) - (XLS) Clinic Facility Fee Schedule.
  • Appendix E (PDF) - (XLS) Emergency Room Fee Schedule.
  • Appendix F (PDF) - (XLS) Ancillary Fee Schedule.
  • Appendix G (PDF) - (XLS) Outpatient Hospital Radiology Fee Schedule.
  • Appendix H Outpatient Hospital Laboratory Fee Schedule has been rescinded. Please refer to the Laboratory Services Fee Schedule for coverage and reimbursement rates of laboratory codes. Please refer to Appendix DD for reimbursement rate of CPT code 36416 (capillary blood draw).

The following fee schedules are applicable for dates of service on or after 4/30/2015 through 12/31/2015: 

  • Appendix A (PDF) - (XLS) Local Level Codes & Modifiers.
  • Appendix B (PDF) - (XLS) Revenue Center Codes Requiring CPT or HCPCS Coding.
  • Appendix C (PDF) - (XLS) Ambulatory Surgery Fee Schedule.
  • Appendix D (PDF) - (XLS) Clinic Facility Fee Schedule.
  • Appendix E (PDF) - (XLS) Emergency Room Fee Schedule.
  • Appendix F (PDF) - (XLS) Ancillary Fee Schedule.
  • Appendix G (PDF) - (XLS) Outpatient Hospital Radiology Fee Schedule
  • Appendix H (PDF) - (XLS) Outpatient Hospital Laboratory Fee Schedule (for services on or after Jan. 1, 2010)

Pharmacy

Pharmacy providers are paid as described in OAC rules 5160-9-05 (drugs including influenza vaccine) and 5160-9-02 (supplies).  Visit Ohio Medicaid Pharmacy website for a searchable database of pharmacy coverage and rates.

Primary Rate Increase

2014 2013

Private Duty Nursing Rates

Provider-Administered Pharmaceuticals

This table (PDF) lists the current coverage and fees for vaccines, injectable medications, and other drugs administered by practitioners. It reflects the policy set forth in the Ohio Administrative Code in rule 5160-4-12.

RN Assessment and RN Consultation Services

Targeted Case Management

Transportation

This table (PDF) lists the current payment amounts for transportation by ambulance or wheelchair van. It reflects the policy set forth in Ohio Administrative Code rule 5160-15-28.

Provider Hotline

MITS Portal