Ohio Administrative Code › Title 5160 - Ohio Department of Medicaid › Chapter 5160-10 - Medical Supplies, Durable Medical Equipment, Orthoses, and Prosthesis Providers › Section 5160-10-28 - DMEPOS: osteogenesis stimulators

Current through all regulations passed and filed through July 1, 2024
(A) Coverage.
(1) Payment may be made for the purchase only
			 of a noninvasive osteogenesis stimulator.
(2) The default certificate of medical
			 necessity (CMN) form is the ODM 07134, "Certificate of Medical Necessity:
			 Osteogenesis Stimulators" (rev. 
									7/2024). The CMN 
									includes an attestation that
			 appropriate coverage criteria are met.
(3) Payment may be made for a spinal
			 electrical osteogenesis stimulator only if at least one of the following
			 criteria is met:
(a) The individual has
			 undergone multilevel spinal fusion surgery;
(b) The individual has undergone spinal
			 fusion surgery that has failed, and at least nine months have elapsed since the
			 most recent operation; or
(c) The
			 individual has undergone spinal fusion surgery, and previous attempts at spinal
			 fusion at the same site have failed.
(4) Payment may be made for a non-spinal
			 electrical osteogenesis stimulator only if at least one of the following
			 criteria is met:
(a) The fracture is in a long
			 bone and has failed to unite for at least three months, which the provider
			 substantiates with the following documentation:
(i) At least two sets of images including
			 multiple views of the fracture site, the first and last of which were taken at
			 least ninety days apart; and
(ii) A
			 written statement by a qualified interpreting practitioner that there has been
			 no clinically significant evidence of fracture healing during the period when
			 the images were taken.
(b) The individual has congenital
			 pseudarthrosis; or
(c) The
			 individual has undergone joint fusion surgery that has failed, and at least
			 nine months have elapsed since the most recent operation.
(5) Payment may be made for an ultrasonic
			 osteogenesis stimulator only if all of the following criteria are met:
(a) The fracture is in a
			  bone other
			 than the skull or a vertebra;
(b) The fracture is not tumor-related;
			 and
(c) The fracture has failed to
			 unite for at least three months, which the provider substantiates with the
			 following documentation:
(i) At least two sets
			 of images including multiple views of the fracture site, the first and last of
			 which were taken at least ninety days apart; and
(ii) A written statement by a qualified
			 interpreting practitioner that there has been no clinically significant
			 evidence of fracture healing during the period when the images were
			 taken.
(6)
			 Payment may be made for either an electrical or an ultrasonic osteogenesis
			 stimulator for an individual who is younger than twenty-one years of age only
			 if all of the following additional criteria are also met:
(a) There is radiological documentation that
			 skeletal maturity has been attained;
(b) The fracture gap is not greater than one
			 half of the diameter of the bone to be treated; and
(c) The fracture does not involve a
			 vertebra.