5160-2-21 Reimbursement for services provided in an outpatient hospital setting.

 

 

 

FEDERAL MEDICAID NOTICE AND PUBLIC HEARING NOTICE OHIO DEPARTMENT OF MEDICAID

 

DATE:                         March 16, 2015

TIME:                        11:00 a.m.

LOCATION:             Room A501, Lazarus Building

50 W. Town St., Columbus, Ohio 43215-3414

 

Pursuant to 42 CFR 447.205, section 1902(a)(13)(A) of the Social Security Act, Chapter

5164.02 and Chapter 119 of the Ohio Revised Code, the director of the Ohio Department of Medicaid gives notice of the Department's intent to amend rule 5160-2-21 on a permanent basis and of a public hearing thereon.

 

Rule 5160-2-21, entitled Policies for outpatient hospital services, is being proposed for amendment in order to reflect the annual Healthcare Common Procedure Coding System (HCPCS) update and pursuant to five year rule review. This rule sets forth polices and payment rates for outpatient services delivered by hospitals that are subject to prospective payment based on diagnosis related groups (DRGs). The title to the rule has been amended to more accurately reflect the content of the rule. In the appendices to this rule, new covered HCPCS codes are added, obsolete HCPCS codes are removed, and the payment schedules associated with the codes are updated. Language in paragraph (B)(4) updates the referral of revenue center codes from Appendix A in rule 5160-2-02 to Appendix I of the Department's Hospital Billing Guidelines. New paragraph (B)(3)(b) contains language regarding setting the initial maximum payment amount for new HCPCS codes at seventy-six percent of the Medicare allowed amount but is not to exceed the Medicaid allowed amount of similar procedure codes effective for dates of service on or after January 1, 2016. Appendix A to this public hearing notice provides a list of procedure codes that were removed from Appendix C as they were deemed inpatient only by the Centers for Medicare and Medicaid Services (CMS). Grammatical and spelling errors were corrected, outdated information was removed, clarifying language was added and a paragraph regarding comprehensive vision exams was moved for improved readability.

 

A copy of the proposed rule is available, without charge, to any person affected by the rule(s) at the address listed below and at the county departments of job and family services. The rule is also available on the internet at  http://www.registerofohio.state.oh.us/. A public hearing on the proposed rule will be held at the date, time, and location listed at the top of this notice. Both written and oral testimony will be taken at the public hearing. Additionally, written comments submitted or postmarked no later than the date of the public hearing will be treated as testimony.

 

Requests for a copy of the proposed rule and testimony on the rule should be submitted by mail to the Ohio Department of Medicaid Rule Administrator, Office of Chief Legal Counsel, 50 W. Town St, Suite 400, Columbus, Ohio 43215-3414, by fax at (614) 752- 3986, or by e-mail at [e-mail]. Testimony received may be reviewed at this address.

 

 

 

 

 

 

Appendix A

The following CPT codes were deleted from Appendix C to 5160-2-21 as they were deemed inpatient only by the Centers for Medicare and Medicaid Services (CMS).

11004	21366	27303	38747	47015	54417	61210
11005	21422	27470	39010	47100	55605	61316
11006	21423	27495	41130	47380	55650	62223
11008	21510	27506	42953	47381	56630	62256
15756	21620	27507	43460	47570	57110	62258
16036	21750	27511	43496	48100	57311	63044
19361	21825	27513	43500	49000	57531	64755
19364	22010	27514	43605	49002	57540	64760
20661	22015	27535	44187	49010	57545	64809
20664	22318	27536	44188	49020	58140	64818
20955	22319	27540	44202	49040	58146	64866
20956	22325	27556	44203	49060	58267	64868
20962	22326	27557	44204	49062	58275	69554
20969	22327	27558	44205	49255	58280
20970	22328	27712	44227	49425	58293
21141	26551	27715	44345	49428	58400
21142	26553	27724	44346	49900	58700
21143	26554	31290	44800	49904	58720
21145	26556	31291	44820	50010	58740
21146	26992	31584	44850	50040	58822
21147	27005	31587	44900	50205	58825
21151	27025	31800	44960	50391	58940
21154	27030	31805	45400	50520	58950
21155	27036	32650	45402	50546	59120
21159	27054	32653	45562	51840	59121
21160	27070	32655	45563	51841	59130
21194	27071	32997	45800	51865	59140
21196	27090	33886	45820	51900	59325
21247	27187	34803	46705	51920	59830
21343	27215	35697	46710	53415	59855
21344	27216	37215	46712	53448	59856
21347	27232	37618	46751	54125	59857
21348	27240	38746	47010	54411	60650