Ohio Admin. Code 4123-6-43 - Payment for transcutaneous electrical nerve stimulators and neuromuscular electrical stimulators
(A) Payment will be approved for a
transcutaneous electric nerve stimulator (TENS) unit for treatment of allowed
conditions in a claim directly resulting
from an allowed industrial
work related injury or occupational disease, as
provided in this rule.
(1) Prior
authorization is required for TENS units and supplies.
A claimant
An
injured worker shall be provided only one TENS unit at a time. For each
TENS unit request approved, the unit shall be rented for a thirty day trial
period before purchase of the TENS unit. This trial period is to evaluate the
medical necessity and effectiveness of the TENS treatment. TENS treatment will
be discontinued at the end of the thirty day trial period
month where the treatment has not proven to
be medically necessary or effective. Reimbursement of rental costs will be
considered only for that portion of the trial
period that the TENS unit was actually used before
if treatment
was discontinued early . For each TENS unit
provided, payment shall be limited to necessary disposable or rechargeable
batteries, but not both.
(2) The
bureau shall apply all rental payments previously made to the purchase price of
the TENS unit. A TENS unit purchased and furnished to the
claimant
injured
worker is not the personal property of the claimant
injured
worker , but remains the property of the bureau or self-insuring employer.
The bureau or self-insuring employer reserves the right to reclaim and recover
the TENS unit from the claimant
injured worker at the completion of the course of
TENS treatment. Once a TENS unit is purchased, the bureau or self-insuring
employer will reimburse for repair or replacement of the unit upon submission
of a request from the physician of record or treating provider that includes
medical documentation substantiating the continued medical necessity and
effectiveness of the unit.
(3) To
be eligible for reimbursement under this rule, the TENS unit must be prescribed
by a physician and furnished by a provider holding a current, valid, license or
certificate of registration from the state of
Ohio respiratory care board
of pharmacy to sell or rent home medical
equipment.
(B) The
claimant's
injured
worker's MCO shall regularly determine the specific TENS supplies needed
by the claimant
injured worker throughout the period of time
authorized for TENS use. The TENS provider must receive authorization from the
claimant's
injured
worker's MCO prior to the delivery of supplies and/or equipment. The TENS
provider shall then deliver the supplies and bill the
claimant's
injured
worker's MCO after authorization is received. A self-insuring employer
may, but is not required to, follow the same procedure as an MCO under this
rule; provided, however, that in no event shall a self-insuring employer
require a claimant
injured worker to submit a written request for TENS
supplies and/or equipment. The claimant's
injured worker's MCO shall retain documentation
of the contact with the claimant
injured worker substantiating the
claimant's
injured
worker's need for supplies in accordance with the time frames set forth
in rule 4123-6-14.1 of the Administrative Code. The TENS provider's bill must
indicate the actual date of service, reflecting the date that services or
supplies were provided. The bureau, MCO, QHP, or self-insuring employer may
adjust bills upon audit if the audit discloses the provider's failure to comply
with this rule.
(C) The TENS
provider shall maintain the following records and make them available for audit
upon request:
(1) Authorizations of TENS
supplies or equipment received from the injured worker's MCO, and all other
documentation relating to the injured worker's need for TENS supplies or
equipment received by the provider prior to the delivery of the supplies or
equipment, including any requests received from the injured worker, if
applicable;
(2) Records of the
provider's wholesale purchase of TENS supplies or equipment;
(3) Records of delivery of supplies to
injured workers and of the delivery or return of TENS units; and
(4) The TENS provider's current, valid,
license or certificate of registration from the state
of Ohio respiratory care board
of pharmacy to sell or rent home medical
equipment.
Upon request, the provider shall supply copies of the record information to the requester at no cost. Failure to provide the requested records may result in denial or adjustment of bills related to these records.
(D) The
bureau shall not pay for the rental or sale of devices that are labeled by the
food and drug administration (FDA) for over-the-counter use and are identified
with the FDA product code "NUH.OTC.TENS."
(E) Payment will be approved for a
neuromuscular electrical stimulator (NMES) unit for treatment of allowed
conditions in a claim directly resulting
from an allowed industrial
work related injury or occupational disease, as
provided in the bureau's provider billing and reimbursement manual in effect on
the billed date of service.
Notes
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, 03/01/2004, 02/01/2010, 12/06/2010, 11/13/2015, 09/01/2016
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
(A) Payment will be approved for a transcutaneous electric nerve stimulator (TENS) unit for treatment of allowed conditions in a claim directly resulting from an allowed industrial work related injury or occupational disease, as provided in this rule.
(1) Prior authorization is required for TENS units and supplies. A claimant An injured worker shall be provided only one TENS unit at a time. For each TENS unit request approved, the unit shall be rented for a thirty day trial period before purchase of the TENS unit. This trial period is to evaluate the medical necessity and effectiveness of the TENS treatment. TENS treatment will be discontinued at the end of the thirty day trial period month where the treatment has not proven to be medically necessary or effective. Reimbursement of rental costs will be considered only for that portion of the trial period that the TENS unit was actually used before if treatment was discontinued early . For each TENS unit provided, payment shall be limited to necessary disposable or rechargeable batteries, but not both.
(2) The bureau shall apply all rental payments previously made to the purchase price of the TENS unit. A TENS unit purchased and furnished to the claimant injured worker is not the personal property of the claimant injured worker , but remains the property of the bureau or self-insuring employer. The bureau or self-insuring employer reserves the right to reclaim and recover the TENS unit from the claimant injured worker at the completion of the course of TENS treatment. Once a TENS unit is purchased, the bureau or self-insuring employer will reimburse for repair or replacement of the unit upon submission of a request from the physician of record or treating provider that includes medical documentation substantiating the continued medical necessity and effectiveness of the unit.
(3) To be eligible for reimbursement under this rule, the TENS unit must be prescribed by a physician and furnished by a provider holding a current, valid, license or certificate of registration from the state of Ohio respiratory care board of pharmacy to sell or rent home medical equipment.
(B) The claimant's injured worker's MCO shall regularly determine the specific TENS supplies needed by the claimant injured worker throughout the period of time authorized for TENS use. The TENS provider must receive authorization from the claimant's injured worker's MCO prior to the delivery of supplies and/or equipment. The TENS provider shall then deliver the supplies and bill the claimant's injured worker's MCO after authorization is received. A self-insuring employer may, but is not required to, follow the same procedure as an MCO under this rule; provided, however, that in no event shall a self-insuring employer require a claimant injured worker to submit a written request for TENS supplies and/or equipment. The claimant's injured worker's MCO shall retain documentation of the contact with the claimant injured worker substantiating the claimant's injured worker's need for supplies in accordance with the time frames set forth in rule 4123-6-14.1 of the Administrative Code. The TENS provider 's bill must indicate the actual date of service, reflecting the date that services or supplies were provided. The bureau, MCO, QHP, or self-insuring employer may adjust bills upon audit if the audit discloses the provider 's failure to comply with this rule.
(C) The TENS provider shall maintain the following records and make them available for audit upon request:
(1) Authorizations of TENS supplies or equipment received from the injured worker's MCO , and all other documentation relating to the injured worker's need for TENS supplies or equipment received by the provider prior to the delivery of the supplies or equipment, including any requests received from the injured worker, if applicable;
(2) Records of the provider 's wholesale purchase of TENS supplies or equipment;
(3) Records of delivery of supplies to injured workers and of the delivery or return of TENS units; and
(4) The TENS provider 's current, valid, license or certificate of registration from the state of Ohio respiratory care board of pharmacy to sell or rent home medical equipment.
Upon request, the
(D) The bureau shall not pay for the rental or sale of devices that are labeled by the food and drug administration (FDA) for over-the-counter use and are identified with the FDA product code "NUH.OTC.TENS."
(E) Payment will be approved for a neuromuscular electrical stimulator (NMES) unit for treatment of allowed conditions in a claim directly resulting from an allowed industrial work related injury or occupational disease, as provided in the bureau's provider billing and reimbursement manual in effect on the billed date of service.
Notes
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, 03/01/2004, 02/01/2010, 12/06/2010, 11/13/2015, 09/01/2016