Ohio Admin. Code 5160-1-60.1 - Special provisions for reimbursement for physician groups acting as outpatient hospital clinics
(A) For physician services rendered on and
after the effective date of this rule by physician group practices that meet
the criteria described in paragraphs (B) and (C) of this rule, the
reimbursement amounts in appendix DD to rule 5101:3-1-60 of the Administrative
Code, except for CPT codes 80002 to 89399, will be multiplied by 1.4. Pregnancy
related services will be reimbursed according to appendix A to rule
5101:3-4-081 of the Administrative Code from March 3, 1992 through March 31,
1992. Pregnancy services will be reimbursed in accordance with appendix DD to
rule 5101:3-1-60 of the Administrative Code from April 1, 1992. For dates of
service May 1, 1994 and thereafter, the following evaluation and management
codes will be reimbursed in accordance with appendix DD to rule 5101:3-1-60 of
the Administrative Code: 99211, 99212, 99213, 99214, and 99215."CPT" as used in
this rule is defined in rule 5101:3-1-19.3 of the Administrative Code.
(B) The physician group practice
is physically attached to a hospital that does not provide physician clinic
outpatient services and the hospital and physician group practice have signed a
letter of agreement indicating that the physician group practice provides the
outpatient hospital clinic service for that hospital.
(C) The Ohio department of job and family
services provider utilization summary for calendar year 1990 establishes that
the physician group practice provides at least forty per cent of the total
number of medicaid physician visits provided in the county in which the
physician group practice is located and an aggregate total of at least ten per
cent of the physician visits provided in the contiguous counties.
Notes
Promulgated Under: 119.03
Statutory Authority: 5164.02
Rule Amplifies: 5164.02
Prior Effective Dates: 03/03/1992 (Emer.), 06/01/1992, 05/02/1994 (Emer.), 07/02/1994, 02/01/2007
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