Ohio Administrative Code
Title 5160 - Ohio Department of Medicaid
Chapter 5160-4 - Physician Services
Section 5160-4-20 - Chemotherapy
Universal Citation: OH Admin Code 5160-4-20
Current through all regulations passed and filed through September 16, 2024
(A) Chemotherapy has two components: administration of a chemotherapeutic agent and the chemotherapeutic agent itself. The administration of chemotherapy includes the preparation of the chemotherapeutic agent and all therapeutic services and medical supplies provided during treatment.
(B) Coverage.
(1)
Chemotherapy provided in a hospital setting (inpatient
hospital, outpatient hospital, emergency department) is a hospital service, for
which payment is made in accordance with Chapter 5160-2 of the Administrative
Code. No separate payment is made to a practitioner for either chemotherapy
administration or a chemotherapeutic agent provided in a hospital
setting.
(2)
Separate payment may be made for chemotherapy
administration that is provided in a non-hospital setting by a practitioner
(such as an oncologist) or by a qualified employee supervised by a
practitioner. Any place-of-service restriction on this provision is shown in
appendix DD to rule
5160-1-60 of the Administrative
Code.
(3)
Separate payment may be made for a chemotherapeutic
agent that is furnished by a practitioner, represents a cost to the
practitioner, and is administered in a non-hospital setting.
(4)
The process of
supervising and monitoring chemotherapy treatment is included in an evaluation
and management service (office visit). The actual administration of
chemotherapy, however, is a professional service that is independent of
evaluation and management. Separate payment may be made for evaluation and
management provided in conjunction with chemotherapy administration in a
non-hospital setting.
Replaces: 5160-4-20
Effective: 1/1/2020
Five Year Review
(FYR) Dates: 01/01/2025
Promulgated Under: 119.03
Statutory Authority:
5164.02
Rule Amplifies: 5164.02
Prior Effective Dates:
09/01/1989, 05/01/1990, 04/01/1992 (Emer.), 07/01/1992, 03/30/1995, 08/02/2011,
01/01/2017
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