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OhioBWC - Provider - Service: (MCO Standardized Prior Authorization Table)
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MCO standardized prior authorization table
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For dates of injury on or after Nov. 1, 2002, BWC has expanded the time frame for presumptive approval to provide services
from the first 45 days to the first 60 days following the injury. We’ve also added services and
clarified others.
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Service
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Requirement
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Physical medicine services, including chiropractic/osteopathic manipulative
treatment and acupuncture
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Prior authorization (PA)
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Consultations - Psychological/chronic pain program only
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PA
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Chronic pain program including pre-admission evaluation and treatment
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PA
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Dental
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PA
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Diagnostic testing (includes labwork)
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PA (except basic X-rays which do not require PA)
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DME
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PA if the purchase price is > $250.00
PA for all DME rental
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Home/auto/van modifications
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PA required from BWC
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Home health agency services
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PA
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All inpatient and outpatient hospital services treatment and ambulatory surgery center services
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PA, except for emergency* services. Emergency inpatient hospitalization may be through the emergency department or by direct admission.
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In-home physician services
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PA after first visit
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Injections
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PA
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Non-emergency ambulance services
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PA
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Orthotic and prosthetic devices and/or repair
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PA >$250
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Skilled Nursing Facility (SNF)/Extended Care Facility (ECF)
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PA
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TENS and NMES units
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PA for both rentals and purchases
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TENS and NMES monthly supplies
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PA for a maximum of six months per authorization
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Vision and hearing services
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PA > $100
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Vocational rehabilitation - All vocational rehabilitation services, in or out of plan
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Note: PA not required for transitional work on-site therapy services provided by
an occupational therapist or physical therapist that fall under the presumptive authorization guidelines.
Note: Occupational rehabilitation (work hardening) requires CARF accreditation.
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*Per Ohio Administrative Code 4123-6-01(O), "Emergency" means: Medical services that are required for the immediate
diagnosis and treatment of a condition that, if not immediately diagnosed and treated, could lead to serious physical
or mental disability or death, or that are immediately necessary to alleviate severe pain. Emergency treatment includes
treatment delivered in response to symptoms that may or may not represent an actual emergency, but is necessary to
determine whether an emergency exists.
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