(A) Acupuncture.
(1) Acupuncture
is
a recognized method of treatment in Ohio and must be administered by a
licensed doctor of medicine, doctor of osteopathic medicine and surgery, or
doctor of podiatric medicine
who has completed a
course of study in acupuncture under the administration of an approved college
of medicine, college of osteopathic medicine and surgery, or college of
podiatric medicine,
a doctor of
chiropractic who holds a certificate to practice acupuncture from the Ohio
state chiropractic board
, or a
registered nonphysician acupuncturist
licensed pursuant to and practicing in compliance with
Chapter 4762. of the Revised Code.
Such
treatment must
(2)
Acupuncture treatment must be prior authorized.
(2) Services provided by a
non-physician acupuncturist must be prescribed by persons licensed under
Chapter 4731. of the Revised Code to practice medicine and surgery or
osteopathic medicine and surgery or podiatry or Chapter 4743. of the Revised
Code to practice chiropractic. A registered non-physician acupuncturist shall
perform acupuncture under the general supervision of the injured worker's
prescribing physician or chiropractic physician. General supervision does not
require that the acupuncturist and the prescribing physician or chiropractic
physician practice in the same office.
(B) Orthotic devices.
(1) Payment is made only for those orthotic
devices prescribed in writing by the physician of record
or treating physician for treatment of an allowed
injury or occupational disease.
The use of the
orthotic device must be directly related to the allowed industrial injury or
occupational disease.
(2)
Orthotic devices shall be custom fitted or custom fabricated and delivered to
the satisfaction of the prescribing physician and the administrative agencies.
Repairs, modifications, and adjustments to secure satisfactory application of
the orthotic appliance shall be made within sixty days of fitting and
application without additional charge by the supplier of the orthotic
device.
(3) No charge shall be made
for measurement, transportation, or other expenses incurred by the
supplier-orthotist, except when the supplier-orthotist is required to travel
beyond the limits of the metropolitan community in which he maintains his place
of business by reason of the physical incapacity of the claimant or by reason
of direct prescription by the attending physician. The supplier-orthotist shall
be paid for traveling expenses on a round-trip basis.
Additional charges must be separately specified on the
supplier-orthotist's billing, including the points of travel and the name of
the physician prescribing the travel. Payment will be made for a maximum of
three round-trip calls.
(4) Once payment for the orthotic
device has been made, replacement requests may be denied in instances of
malicious damage, neglect, culpable irresponsibility or wrongful
disposition.
(C) Dental care.
(1) Payment for dental care
shall
will be
made in the following cases:
(a) Where
an injury or industrial accident not only causes an
injury, but
the work related accident causing
the injury also results in the damage or loss of the
claimant's
injured
worker's artificial teeth or other denture. Once the artificial teeth or
other denture(s) have been repaired, replaced, or adjusted, no further
repair, replacement
, or
adjustment will be approved.
(b) Where
an
industrial
a work related injury or
occupational disease
either has caused
damage or
has adversely affected the
claimant's
injured
worker's natural teeth.
Once payment for the
artificial teeth or other denture(s) has been made, replacement requests may be
denied in instances of malicious damage, neglect, culpable irresponsibility or
wrongful disposition.
(2) Responsibility for injuries or
occupational diseases affecting the claimant's natural teeth is limited to the
repair or replacement of those teeth actually injured at the time of the
accident, or directly affected by the injury or disease. This responsibility
does not include the replacement of teeth which are extracted or repaired for
purposes unrelated to the industrial injury or occupational
disease.
(3)(2) Responsibility for
the repair of both natural and artificial teeth is limited to the damage done
at the time of the accident, or to the damage directly caused by an allowed injury or
occupational disease.
(D)
Eyeglasses and contact lenses.
(1) Payment
for eyeglasses or contact lenses
shall
will be made in the following cases:
(a) Where
an
industrial injury or an industrial
the work
related accident
not only causes an
causing the injury
,
but also results in the damage or loss of the
claimant's
injured
worker's eyeglasses or contact lenses. Once the eyeglasses or contact
lenses have been repaired, replaced, or adjusted, no further
repair, replacement
, or
adjustment will be approved.
(b) Where loss of vision is the
direct result of an allowed injury or
occupational disease. Once payment for the
eyeglasses or contact lenses has been made, replacement requests can be denied
in instances of malicious damage, neglect, culpable irresponsibility or
wrongful disposition.
(2) Refractions will be approved in
situations described in paragraph (D)(1)(b) of this rule.
(3)
Replacement of
glasses with contact lenses is approved when
When medical evidence indicates a
direct need due to an allowed injury or
occupational disease
contact lenses may be approved
instead of eyeglasses.
(4)
Glasses or contact lenses will be approved for treatment purposes, when
necessary, as a
direct result of the
allowed injury or occupational disease. Any subsequent adjustment
, maintenance supplies or change in
a claimant's
an
injured worker's glasses or contact lenses, if required for treatment of
the allowed injury or occupational disease, will also be approved
when supported by evidence of a direct causal
relationship.
(E) Hearing aids.
Payment for hearing aids will be made
in the following cases:
(1)
Payment for hearing aid(s) should be made where an
industrial
Where the work related accident
causing the injury
or an industrial accident
not only causes an injury, but also results in the damage or loss of
the claimant's hearing aid(s) Once the hearing aid(s) have been repaired,
replaced, or adjusted, no further
repair,
replacement
or adjustment will be
approved.
(2) When a partial loss
of hearing is the direct result of an
allowed industrial injury or occupational
disease, payment for a hearing aid(s) is justified
in order to improve the claimant's ability to hear.
(F)
X-rays.
Medical
imaging.
Payment for x-ray examinations (including CT, MRI, and
discogram) shall be made when medical evidence shows that the examination is
medically necessary either for the treatment of an allowed injury or
occupational disease, or for diagnostic purposes to pursue more specific
diagnoses in an allowed claim. Providers shall follow all prior authorization
requirements in effect at the time when requesting authorization and payment
for such studies.
(G)
Once payment for orthotic devices, artificial teeth or
other dentures, eyeglasses, contact lenses, or hearing aids has been made,
replacement requests may be denied in instances of malicious damage, neglect,
culpable irresponsibility, or wrongful disposition.
Notes
Ohio Admin. Code 4123-6-31
Effective:
2/1/2022
Five Year Review (FYR) Dates:
11/12/2021 and
02/01/2027
Promulgated
Under:
119.03
Statutory Authority:
4121.12,
4121.121,
4121.30,
4121.31,
4121.44,
4121.441,
4123.05,
4123.66
Rule Amplifies:
4121.12,
4121.121,
4121.44,
4121.441,
4123.66
Prior Effective Dates: 02/12/1997, 10/14/2002, 10/10/2003,
02/14/2005, 09/22/2008, 02/01/2010,
11/13/2015