Ohio Administrative Code|Rule 5160-8-51 | Acupuncture services.

                                                
(A) Definitions.
(1) "Acupuncture" has the same meaning as in
			 Chapter 4762. 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 acupuncture services by virtue of holding a
				credential specified by law (e.g., a physician or a chiropractor).
(2) Billing
			 ("pay-to") provider. The following eligible providers may receive
			 medicaid payment for submitting a claim for a covered acupuncture
			 service:
(a) An acupuncturist recognized under section 4762.02 of
				the Revised Code;
(b) An individual practitioner, other than an
				acupuncturist, who may render acupuncture services by virtue of holding a
				credential specified by law;
(c) An outpatient rehabilitation clinic, primary care
				clinic, or public health department clinic that meets the criteria set forth in
				Chapter 5160-13 of the Administrative Code;
(d) A federally qualified health center
				(FQHC);
(e) A rural health clinic (RHC);
(f) An individual practitioner who supervises an
				acupuncturist or other credentialed acupuncture provider;
(g) A professional medical group; or
(h) A hospital.
(C) Coverage.
(1) Payment may be made
			 only for an acupuncture service that meets the following criteria:
(a) It is medically necessary in accordance with rule
				5160-1-01 of the Administrative Code;
(b) It is performed in accordance with section 4762.10 or
				4762.11 of the Revised Code; and
(c) It is rendered for treatment only of the following
				conditions:
(i) Low back
				  pain;
(ii) Migraine;
(iii) Cervical (neck)
				  pain;
(iv) Osteoarthritis of
				  the hip;
(v) Osteoarthritis of the
				  knee;
(vi) Nausea or vomiting
				  related to pregnancy or chemotherapy; or
(vii) Acute
				  post-operative pain.
(2) Payment for more than
			 thirty acupuncture visits per benefit year is subject to prior
			 authorization.
(3) No separate payment
			 is made for both an evaluation and management service for any of the conditions
			 listed in this rule and an acupuncture service rendered by the same provider to
			 the same individual on the same day.
(4) No separate payment
			 is made for services that are an incidental part of a visit (e.g., providing
			 instruction on breathing techniques, diet, or exercise).
(5) No separate payment
			 is made to a non-physician acupuncture provider who performs an acupuncture
			 service in a hospital setting. Instead, the provider makes payment arrangements
			 directly with the participating hospital.
(6) No payment will be
			 made for additional treatment in either of the following
			 circumstances:
(a) Symptoms show no evidence of clinical improvement after
				an initial treatment period; or
(b) Symptoms worsen over a course of
				treatment.
(D) Claim payment.
(1) For a covered
			 acupuncture service rendered at an FQHC or RHC, payment is made in accordance
			 with Chapter 5160-28 of the Administrative Code.
(2) For a covered
			 acupuncture service rendered at any other valid place of service, payment is
			 the lesser of the provider's submitted charge or the maximum amount
			 specified in appendix DD to rule 5160-1-60 of the Administrative
			 Code.


Last updated April 8, 2021 at 1:29 PM