Ohio Administrative Code
Title 5160 - Ohio Department of Medicaid
Chapter 5160-10 - Medical Supplies, Durable Medical Equipment, Orthoses, and Prosthesis Providers
Section 5160-10-14 - DMEPOS: compression garments

Universal Citation: OH Admin Code 5160-10-14

Current through all regulations passed and filed through September 16, 2024

(A) The default certificate of medical necessity (CMN) form is the ODM 01905, "Certificate of Medical Necessity: Compression Garments" (rev. 7/2024).

(B) Payment may be made only for compression garments generating a pressure of at least eighteen millimeters of mercury (mm Hg).

(C) For a gradient compression garment, the provider specifies at least one clinical indication such as but not limited to the conditions identified in the following list:

(1) Elephantiasis;

(2) Lymphedema;

(3) Milroy's disease;

(4) Orthostatic hypotension;

(5) Post-thrombotic syndrome;

(6) Stasis dermatitis;

(7) Stasis ulcers;

(8) Symptomatic chronic venous insufficiency (characterized by, for example, pain, swelling, ulcers, or severe varicose veins);

(9) Symptomatic venous insufficiency associated with pregnancy; or

(10) Thrombophlebitis.

(D) Payment for an anti-embolism compression garment may be limited to three months, because such garments are generally used for short-term treatment after surgery.

(E) Payment for a post-burn compression garment cannot be made if no burn injury has occurred.

(F) It is understood that because of the nature of certain applications, authorization for payment may be granted after an item has been dispensed.

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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