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Fee Schedules and Rates

Ambulatory Surgical Centers

ASC Rates – ASCs are paid a facility fee for certain procedure codes. These codes are noted in the "Current ASC Group" column of the Medicaid Fee Schedule above.

Durable Medical Equipment

Prescriptions for DME, medical supplies, orthotics or prosthetics must have originated as a result of a face-to-face encounter between the prescriber and the consumer. This encounter must occur no more than 180 days to the prescription being written and cannot occur following the date the prescription is written. (XLS)

Use of either the RT or LT modifiers is required when billing for the codes for items having the same billing code and dispensed bilaterally on the same date of service for the same consumer, both the RT and the LT modifier must be used. (XLS)

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

Inpatient Hospital Services

Medicaid Non-Institutional Fee Schedule

This fee schedule (PDF) - (XLS) 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.

Medicaid Fee Schedule for Community Behavioral Health Providers

Outpatient Hospital Services

The Outpatient Fee Schedules are several Appendices of Ohio Administrative Code Rule 5160-2-21. For outpatient hospital laboratory service provided prior to January 1, 2010, please refer to the Medicaid Fee Schedule above.

  • 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 http://medlist.ohio.gov 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 5101:3-4-12.

Targeted Case Management

Provider Hotline

MITS
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