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ODM Announces New Telehealth Rule & Other Billing/Coding Updates


New telehealth rule 5160-1-18 took effect on 11/15. Since the emergency rules have expired, this rule ensures an expanded telehealth policy continues under the public health emergency. The Telehealth billing guidelines are now posted on the Ohio Department of Medicaid (ODM) website in the following locations:

The clinical lab fee schedule will be updated to reflect new coverage determination and payment rates. These changes are expected to be effective January 1, 2021. COVID testing and specimen collection codes developed by the American Medical Association (AMA) are covered by ODM. These codes are located in the clinical laboratory fee schedule. 

New COVID vaccine codes have recently been established by the AMA. ODM is tracking the Emergency Use Authorization (EUA) application for the Pfizer vaccine so that an effective date can be made available as soon as possible. These vaccines are currently priced at $0.01 due to them being distributed to providers at no cost. After the public health emergency (PHE) has ended, new rates will be established for these vaccines.

As of January 1, 2021, ODM will adopt the HCPCS codes maintained by the Centers for Medicare and Medicaid Services (CMS) for the reporting of definitive urine drug tests and will no longer recognize the definitive drug test CPT codes established by the AMA. This change affects definitive urine drug tests only; providers reporting presumptive urine drug screens will continue to use CPT codes (80305 – 80307). ODM will be updating the laboratory fee schedule as a result of this change.

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