Ohio Administrative Code
Title 5160 - Ohio Department of Medicaid
Chapter 5160-10 - Medical Supplies, Durable Medical Equipment, Orthoses, and Prosthesis Providers
Section 5160-10-35 - DMEPOS: cranial remolding devices

Universal Citation: OH Admin Code 5160-10-35

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

(A) No particular form or format is specified for the certification of medical necessity.

(B) Payment may be made only for a cranial remolding device that meets the standards established by the United States food and drug administration for a class II medical device.

(C) Payment may be made for the purchase of a cranial remolding device to treat any of the following conditions if the associated criteria are met.

(1) Positional (non-synostotic) plagiocephaly:
(a) The individual is at least three months old but not older than eighteen months;

(b) Any of the following asymmetries is present:
(i) A right/left discrepancy in the skull base of at least six millimeters, measured subnasally to the tragus;

(ii) A right/left discrepancy in the cranial vault of at least ten millimeters, measured from the frontozygomaticus point to the euryon; or

(iii) A right/left discrepancy in the orbitotragial distances of at least four millimeters; and

(c) The asymmetry has not substantially improved after two months of conservative cranial repositioning therapy or physical therapy.

(2) Positional (non-synostotic) braciocephaly: The cephalic index (the ratio of the maximum width of the head to its maximum length) is greater than ninety-one per cent.

(3) Positional (non-synostotic) scaphocephaly: The cephalic index is less than seventy-five per cent.

(4) Synostotic deformity:
(a) The individual is not older than eighteen months;

(b) Premature closing of the cranial structures has been documented; and

(c) Surgery with post-operative remolding is medically indicated.

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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