Rule 5160-15-25. Transportation: services from an eligible provider: points of transport

119.03 (A) For purposes of this chapter, medicaid recognizes the following twelve points of transport, which represent the origin or destination of a discrete one-way trip: (1) Ten points of transport recognized by the centers for medicare and medicaid services (CMS): (a) A diagnostic or therapeutic site other than a practitioner's office or a hospital, such as an alcohol and drug rehabilitation center, an ambulatory surgery center, an independent diagnostic testing facility, or a medical equipment supplier; (b) A residential, domiciliary, or custodial facility that is not a skilled nursing facility; (c) A dialysis facility located in a hospital; (d) A hospital; (e) A site of transfer between modes of transport, such as an airstrip or a helipad; (f) A dialysis facility not located in a hospital; (g) A skilled nursing facility; (h) A practitioner's office, which includes but is not limited to the office of an individual health professional, the office of a group of health professionals, or a clinic; (i) A residence other than a residential, domiciliary, or custodial facility; and (j) The scene of an accident or an acute event; (2) A workplace; and (3) A school. (B) On each claim for a transportation service provided by wheelchair van or by ambulance, the origin and the destination are specified in accordance with current claim-submission instructions. (1) A claim submitted for a wheelchair van service or an ambulance service is subject to manual review unless the combination of origin and destination has been exempted. A list of the exempted combinations for each service is shown in the appendix to rule 5160-15-28 of the Administrative Code. (2) Transportation providers may request manual review of claims for services involving non-exempted combinations of origins and destinations. Transportation providers may also request manual review of a claim for a service involving an origin or destination not listed in paragraph (A) of this rule if they indicate that fact explicitly on the claim. (3) A request for manual review of a claim for a transportation service includes the following information: (a) A completed practitioner certification form when the claim does not concern emergency ambulance service; (b) A complete description of the service requested, the date of service, the trip origin and destination, a description of any special services involved, and a justification for the use of an attendant (when applicable); and (c) Details of any related circumstances that should be considered in the evaluation of the request for manual review. Last updated May 11, 2026 at 1:01 PM Supplemental Information Authorized By: 5164.02 Amplifies: 5164.02 3/1/2031 12/27/2001, 3/27/2006