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Ohio Administrative Code (Last Updated: January 12, 2021) |
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5160 Medicaid |
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Chapter5160-4. Physician Services |
5160-4-20. Chemotherapy
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(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.