Ohio Administrative Code
Title 5160 - Ohio Department of Medicaid
Chapter 5160-15 - Medical Transportation Services
Section 5160-15-25 - Transportation: services from an eligible provider: points of transport
Universal Citation: OH Admin Code 5160-15-25
Current through all regulations passed and filed through September 16, 2024
(A) For purposes of this chapter, medicaid recognizes the following twelve points of transport, which represent the origin or destination of a discrete one-way trip:
(1) Ten points of transport recognized by the
centers for medicare and medicaid services (CMS):
(a) A diagnostic or therapeutic site other
than a practitioner's office or a hospital, such as an alcohol and drug
rehabilitation center, an ambulatory surgery center, an independent diagnostic
testing facility, or a medical equipment supplier;
(b) A residential, domiciliary, or custodial
facility that is not a skilled nursing facility ;
(c) A dialysis facility located in a
hospital;
(d) A hospital;
(e) A site of transfer between modes of
transport, such as an airstrip or a helipad;
(f) A dialysis facility not located in a
hospital;
(g) A skilled nursing
facility;
(h) A practitioner's
office, which includes but is not limited to the office of an individual health
professional,
the office of a
group of health professionals,
or a clinic;
(i) A residence other than a residential,
domiciliary, or custodial facility; and
(j) The scene of an accident or an acute
event;
(2) A workplace;
and
(3) A school.
(B) On each claim for a transportation service provided by wheelchair van or by ambulance, the origin and the destination are specified in accordance with current claimsubmission instructions.
(1) A claim
submitted for a wheelchair van service or an ambulance service
is subject
to manual review unless the combination of origin and destination has
been exempted. A list of the exempted combinations for each service is shown in
the appendix to rule
5160-15-28 of the Administrative
Code.
(2) Transportation providers
may request manual review of claims for services involving non-exempted
combinations of origins and destinations. Transportation providers may also
request manual review of
a
claim for a service involving an origin or destination not listed in
paragraph (A) of this rule
if
they indicate that fact explicitly on the
claim.
(3)
A
request for manual review of a claim for a transportation service
includes the following information:
(a) A completed practitioner certification
form when the claim does not concern emergency ambulance service;
(b) A complete description of the service
requested, the date of service, the trip origin and destination, a description
of any special services involved, and a justification for the use of an
attendant (when applicable); and
(c) Details of any related circumstances that
should be considered in the evaluation of the request for manual
review.
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