12/07/2017

Department of Medicaid Proceeds with Acupuncture Reimbursement for DCs; OSCA Releases Details

(COLUMBUS, OH) After a resubmission of earlier proposed Medicaid rule, the department is now proceeding forward with implementing reimbursement for Doctors of Chiropractic who perform acupuncture on their patients for a live effective date of January 1st, 2018. “This rule is a compilation of a lot of hard work from a lot of different individuals and groups,” said Nicholas Strata. “We applaud the department [ODM) for moving forward with this rule. Should people have specific questions on the rule they should reach out to Dr. Brandy Spaulding at the OSCA.”

Below are the details:

Coverage:

• Low back pain;
• Migraines

Payment for more than thirty acupuncture visits per benefit year requires prior authorization.

No separate payment is made for both an evaluation and management service and acupuncture service rendered by the same provider to the same individual on the same day

For more information on the rule click here.

Acupuncture Procedure Codes and Payment Amount:

Acupuncture Services - Information for Medicaid Providers

Provider requirements, coverage, and payment information for acupuncture services can be found in the attached Ohio Administrative Code rule, which will be published on LAWriter (http://codes.ohio.gov/oac/5160) when the rule becomes effective on January 1, 2018.

Practitioners will be able to enroll as Acupuncturists or another type of Medicaid provider with an acupuncture specialty (e.g., chiropractor with an acupuncture specialty, physician assistant with an acupuncture specialty) starting mid-December 2017.

If a practitioner wishes to enroll with Medicaid for the first time, the practitioner may enroll as a Medicaid provider following this link: https://portal.ohmits.com/Public/Providers/Enrollment/tabId/44/Default.aspx. Providers may also call: (800) 686-1516.

If the practitioner is already a Medicaid provider, the provider may request an acupuncture provider type specialty (023) by sending a written request along with supporting documentation to the following email address: Medicaid_provider_update@medicaid.ohio.gov (see provider requirements in the attached Ohio Administrative Code rule). Or, the provider may fax their request with the required supporting documentation to (614) 995-5904. To expedite the process, providers should write the following information in the subject line of their e-mail or fax: Requesting Addition of Acupuncture Specialty. This way, the request can be quickly routed to the proper personnel for processing.

Information regarding Medicaid’s payment system (MITS) and submitting fee-for-service claims can be found at http://medicaid.ohio.gov/PROVIDERS.aspx. You may also call Medicaid’s Provider Hotline at (800) 686- 1516. MITS training information is located online at: http://medicaid.ohio.gov/PROVIDERS/Training/BasicBilling.aspx. We will also be developing training specifically for acupuncture services (date to be determined). If you would like to schedule a one-on-one billing consultation, you may make a request by emailing Ombudsmen_training@medicaid.ohio.gov.

Since most individuals covered by Medicaid are enrolled with a Medicaid managed care plan (MCP), practitioners will also need to reach out to each MCP to learn about their provider enrollment and claims submission processes. MCP contact information is as follows: