Ohio Admin. Code 5160-10-35 - DMEPOS: cranial remolding devices
(A)
Any cranial
remolding device for which payment is requested must meet the standards
established by the United States food and drug administration for a class II
medical device.
(B)
Payment may be made for the purchase of a cranial
remolding device to treat any of the following conditions if the associated
criteria are met.
(1)
Positional (non-synostotic) plagiocephaly:
(a)
The individual is
at least three months old but not older than eighteen months;
(b)
Any of the
following asymmetries is present:
(i)
A right/left discrepancy in the skull base of at least
six millimeters, measured subnasally to the tragus;
(ii)
A right/left
discrepancy in the cranial vault of at least ten millimeters, measured from the
frontozygomaticus point to the euryon; or
(iii)
A right/left
discrepancy in the orbitotragial distances of at least four millimeters;
and
(c)
The asymmetry has not substantially improved after two
months of conservative cranial repositioning therapy or physical therapy.
(2)
Positional (non-synostotic) braciocephaly: The cephalic
index (the ratio of the maximum width of the head to its maximum length) is
greater than ninety-one per cent.
(3)
Positional
(non-synostotic) scaphocephaly: The cephalic index is less than seventy-five
per cent.
(4)
Synostotic deformity:
(a)
The individual is
not older than eighteen months;
(b)
Premature closing
of the cranial structures has been documented; and
(c)
Surgery with
post-operative remolding is medically indicated.
Replaces: 5160-10-35
Notes
Promulgated Under: 119.03
Statutory Authority: 5164.02
Rule Amplifies: 5164.02
Prior Effective Dates: 09/01/2011
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