Ohio Administrative Code
Title 5160 - Ohio Department of Medicaid
Chapter 5160-10 - Medical Supplies, Durable Medical Equipment, Orthoses, and Prosthesis Providers
Section 5160-10-02 - DMEPOS: repair
Universal Citation: OH Admin Code 5160-10-02
Current through all regulations passed and filed through September 16, 2024
(A) Definitions.
(1) "Major repair" is a repair for which the
combined medicaid allowed amounts for materials and labor exceed one hundred
twenty dollars for an orthotic or prosthetic device or one hundred dollars for
any other item.
(2) "Minor repair"
is a repair for which the combined medicaid allowed amounts for materials and
labor do not exceed one hundred twenty dollars for an orthotic or prosthetic
device or one hundred dollars for any other item. Reporting a major repair on a
claim as a series of minor repairs is not permitted.
(B) Coverage.
(1) Provisions governing the repair of
wheelchairs are set forth in rule
5160-10-16 of the Administrative
Code.
(2) Need verification is
necessary before payment can be made for the following
repairs made to a particular item:
(a) The
initial repair made to an item that was not purchased by the
department;
(b) Major repairs;
and
(c) Minor repairs in excess of
one per one hundred twenty days.
(3)
The default form
on which to submit a request for need verification
(RNV) is the ODM 01904, "Request for Need
Verification: Repair of Durable Medical Equipment (Other Than Wheelchairs),
Prostheses, or Orthotic Devices" (rev. 7/2018)
. An RNV includes the
following information:
(a) Specification of
the item, including manufacturer, model, and serial number (if
applicable);
(b) The date on which
the item was originally purchased or dispensed or, if the date is not known,
the approximate age of the item;
(c) Any warranty period and the type of
warranty (manufacturer or dealer);
(d) A full description of the wear, damage,
or malfunction;
(e) A full
description of the repair;
(f) A
description, with dates, of previous repairs (both major and minor);
(g) A complete itemization of parts;
and
(h) An estimate of labor time
needed.
(4) Providers
should advise the department when, in their professional opinion, replacement
of an item would be more cost-effective than repair.
(5) No separate payment will be made for the
following items or services:
(a) Temporary
replacement ("loaner") equipment provided while an individual's own equipment
is being repaired;
(b) Repair of an item if within the preceding
twelve months
medicaid payment has been made for the repair of
a duplicate or conflicting item currently in the
individual's possession;
or
(c)
Repair of an item that is no longer deemed to be
medically necessary.
Disclaimer: These regulations may not be the most recent version. Ohio may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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