Ohio Administrative Code
Title 5160 - Ohio Department of Medicaid
Chapter 5160-4 - Physician Services
Section 5160-4-03 - Services provided by a physician assistant
Universal Citation: OH Admin Code 5160-4-03
Current through all regulations passed and filed through September 16, 2024
(A) Definitions.
(1)
"Physician assistant" has the same meaning as in
Chapter 4730. of the Revised Code.
(2)
"Physician" has
the same meaning as in section
4730.01 of the Revised
Code.
(3)
"Health care facility" has the same meaning as in
section 4730.01 of the Revised
Code.
(4)
"Service" has the same meaning as in section
4730.01 of the Revised
Code.
(B) Coverage. For a covered service performed by a physician assistant who is currently enrolled as an Ohio medicaid provider, payment may be made only if the physician assistant practices under either of the following arrangements:
(1)
The physician assistant provides services under the
supervision, control, and direction of a physician with whom the physician
assistant has entered into a supervision agreement under section
4730.19 of the Revised Code;
or
(2)
The physician assistant practices in a health care
facility and provides services the facility has authorized the physician
assistant to perform.
(C) Payment.
(1)
For
assistant-at-surgery services performed by a physician assistant, payment is
twenty-five per cent of the medicaid maximum for the covered primary surgical
procedure.
(2)
For a covered immunization, injection of medication, or
provider-administered pharmaceutical, payment is made in accordance with rule
5160-4-12 of the Administrative
Code.
(3)
For all other covered services performed by a physician
assistant, payment is the lesser of the billing provider's submitted charge or
eighty-five per cent of the medicaid maximum.
(4)
Payment for
services provided by a hospital-employed physician assistant will be made to
the hospital.
Replaces: 5160-4-03
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.
This site is protected by reCAPTCHA and the Google
Privacy Policy and
Terms of Service apply.
