"Advanced practice registered nurse (APRN)" has the same meaning as in Chapter
4723-08 of the Administrative Code. The term encompasses a certified registered
nurse anesthetist (CRNA), clinical nurse specialist (CNS), certified
nursemidwife (CNM), and certified nurse practitioner (CNP).
(1) Unless a specific exception is noted, all
other rules in agency 5160 of the Administrative Code that pertain to services
rendered by a physician apply also to services rendered by an APRN.
Payment may be
a covered service rendered
by an APRN, payment may be made
only if the
following conditions are met:
(a) The APRN is currently enrolled
as an Ohio medicaid provider;
The service is
in a state in which the APRN
is licensed or authorized to practice;
(c)(b) The service is
within the scope of practice of the APRN's specialty;
The APRN personally rendered the service to an individual patient;
The service cannot
be performed by someone who lacks the skills and training of an APRN.
(3) An APRN employed by or under
contract with a physician, group practice, hospital, long-term care facility,
or other medicaid provider must not submit a claim for service that would
result in duplicate payment.
Payment for a covered service rendered by
a CRNA is made in accordance with rule
the Administrative Code.
Payment for a covered service rendered by a CNS, CNM, or CNP is the lesser of
the billing provider's submitted charge or the applicable amount from the
(a) For a covered service
rendered in a hospital setting (inpatient hospital, outpatient hospital, or
hospital emergency department), eighty-five per cent of the medicaid
(b) For a covered service
rendered in a non-hospital setting, one hundred per cent of the medicaid
assistant-at-surgery services provided by a CNS, CNM, or CNP regardless of
setting, twenty-five per cent of the medicaid maximum for the covered primary
Payment for services rendered by a hospital-employed APRN will be made to the
In the event that payment for a covered service
performed by an APRN is issued both to the APRN and to a contracting or
supervising provider on behalf of the APRN, one of the issued payments is
subject to recovery.
Ohio Admin. Code
Five Year Review (FYR) Dates:
Prior Effective Dates: 09/24/1983, 04/01/1988, 05/15/1989,
03/01/1994 (Emer.), 05/12/1994, 05/01/1997, 06/01/2002, 01/01/2008, 01/01/2017,