Section 5160-8-34 - Skilled therapy: payment(A) If more than one skilled therapy service of the same discipline (e.g., physical therapy) is rendered by the same non-institutional provider or provider group to a recipient on the same date, then the service with the highest payment amount specified in appendix DD to rule 5160-1-60 of the Administrative Code is considered the primary procedure. The maximum payment amount for a skilled therapy service is the lesser of the provider's submitted charge or a percentage of the amount specified in appendix DD to rule 5160-1-60 of the Administrative Code, determined in the following manner: (1) For the first unit of a primary procedure, one hundred per cent.(2) For each additional unit or procedure within the same therapy discipline, eighty per cent.(B) Services reported on claims must correspond to the services listed in the treatment plan.(C) Providers must report appropriate procedure codes and modifiers on claims.(D) Unattended electrical stimulation and iontophoresis therapy are considered to be part of the associated therapy procedure or medical encounter; no separate payment is made.(E) Skilled therapy performed during an inpatient hospital stay is treated as a hospital service.(F) Payment for skilled therapy services rendered to a resident of a nursing facility (NF) is made to the NF through the facility per diem payment mechanism. A non-institutional provider that renders a skilled therapy service to a NF resident must seek payment from the NF.Ohio Admin. Code 5160-8-34
Effective: 10/1/2018
Five Year Review (FYR) Dates: 6/26/2018
Promulgated Under: 119.03
Statutory Authority: 5164.02
Rule Amplifies: 5162.03, 5165.47, 5164.70, 5164.06, 5164.02
Prior Effective Dates: 01/01/2008, 07/31/2009 (Emer.), 10/29/2009, 01/01/2014, 07/31/2014