– 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.
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
These providers are reimbursed for specific procedure codes as detailed in the Appendix
of Ohio Administrative Code Rule 5101:3-18-01
- 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
- Hospice Rates FFY 2012 – October 1, 2012 – September 30, 2012
- Hospice Rates FFY 2011 – October 1, 2010 – September 30, 2011
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.
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 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.
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