Ohio Administrative Code
Title 5160 - Ohio Department of Medicaid
Chapter 5160-10 - Medical Supplies, Durable Medical Equipment, Orthoses, and Prosthesis Providers
Section 5160-10-30 - DMEPOS: ambulation aids
Universal Citation: OH Admin Code 5160-10-30
Current through all regulations passed and filed through September 16, 2024
(A) Definitions.
(1) "Ambulation aid" is a collective term for
a cane, crutch, or walker.
(2)
"Ambulatory limitation" is an impediment to walking that has either of two
effects:
(a) It prevents an individual from
completing activities of daily living within a reasonable time (or at all);
or
(b) It places an individual at a
demonstrably higher risk of injury, exacerbation of illness, or death when
activities of daily living are performed.
(B) Coverage.
(1)
No particular
form or format is specified for the certification of medical
necessity.
(2) Payment may be made
for a covered ambulation aid if all of the following criteria are met:
(a) The individual has an ambulatory
limitation that is documented in the individual's medical record;
(b) The ambulation aid has been prescribed by
a qualified practitioner;
(c) The
individual is able to use the ambulation aid safely; and
(d) The ambulation aid reduces the ambulatory
limitation enough to permit the individual to complete activities of daily
living in a reasonable amount of time and with a reasonable degree of
safety.
(3) Additional coverage
criteria are specific to particular ambulation aids:
(a) For a heavy-duty walker, the individual
weighs at least three hundred pounds.
(b) For a heavy-duty walker with multiple
braking system and variable wheel resistance (a four-wheeled walker having at
least two wheels with hand-operated brakes that can be independently adjusted
and lock the wheels when either or both hand levers are released), the
individual both weighs at least three hundred pounds and is unable to use a
standard heavy-duty walker because the use of one hand is restricted.
(c) For an enclosed-frame walker, the
prescriber describes and attests in writing to the medical necessity, and the
provider keeps a copy of this document in the individual's file.
(d) For a trunk-support walker, the
prescriber describes and attests in writing to the medical necessity, and the
provider keeps a copy of this document in the individual's file.
(e) For walker leg extensions, the individual
stands at least six feet tall.
(f)
For a white cane that is to be used as a mobility aid, the provider maintains
documentation that the individual cannot obtain an equivalent cane free of
charge (e.g., from a source such as the "Free White Cane Program" administered
by the national federation of the blind, http://nfb.org ).
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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