Reimbursement for ambulatory surgery center services are processed using 3M’s Enhanced Ambulatory Patient Groups (EAPG). Services provided on or after January 2, 2020 will be processed using EAPG Version 3.14. Services provided on or after August 1, 2017 and on or before January 1, 2020 will be processed using Version 3.9. Please refer to Ohio Administrative Code rule 5160-22-01 and the ambulatory surgery center billing guidelines for additional information about EAPG payment methodology.
EAPG Covered Codes (PDF) (XLSX) Base Rate:
Cost-to-Charge Ratio:
EAPG Adjuster:
EAPG Relative Weight Table EAPG Claim Examples
Effective for dates of service prior to 8/1/17. 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.
This table (PDF) (XLSX) lists the current fees for Current Dental Terminology (CDT) procedure codes. It reflects the policy set forth in Ohio Administrative Code rule 5160-5-01.
The main DMEPOS payment schedule lists the current maximum payment amounts for many durable medical equipment items, prostheses, orthoses, and medical supplies. It reflects the policy set forth in Ohio Administrative Code Chapter 5160-10. (XLSX)
The Oxygen payment schedule lists the current maximum payment amounts for oxygen. It reflects the policy set forth in Ohio Administrative Code rule 5160-10-13. (XLSX)
The Wheelchair payment schedule 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. (XLSX)
The fee schedule for Home and Community Based Services can be found at: Chapters 5123:2-9/5123-9 Home and Community-Based Services Waiver
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.
Reimbursement for outpatient hospital services are processed using 3M’s Enhanced Ambulatory Patient Groups (EAPG). Services provided on or after January 2, 2020 will be processed using EAPG Version 3.14. Services provided on or after August 1, 2017 and on or before January 1, 2020 will be processed using Version 3.9. Please refer to Ohio Administrative Code rule 5160-2-75 and the hospital billing guidelines for additional information about EAPG payment methodology.
The Outpatient Fee Schedules are several Appendices of Ohio Administrative Code Rule 5160-2-21, effective through 7/31/17.
The following fee schedules are applicable for dates of service on or after 10/1/2016:
The following fee schedules are applicable for dates of service on or after 1/1/2016:
The following fee schedules are applicable for dates of service on or after 4/30/2015 through 12/31/2015:
The following information pertains to Behavioral Health Services provided by an outpatient hospital for dates of service on or after August 1, 2017:
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.
This table (XLS) 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.
The rates for targeted case management can be found at: TCM