# Ohio Admin. Code 5160-12-06: Rule 5160-12-06. Reimbursement: private duty nursing services > Ohio · Regulations · In force URL: https://www.frixlaw.com/law-library/statutes/STATE_OH_ADC_5160_12_06 ## Section - **Citation:** Ohio Admin. Code 5160-12-06 - **Heading:** Rule 5160-12-06. Reimbursement: private duty nursing services - **Jurisdiction:** Ohio - **Kind:** Regulations - **Status:** In force - **Text as of:** August 14, 2026 - **Source:** Compiled text - **Location:** Ohio Administrative Code / Agency 5160 / Chapter 5160-12 / Rule 5160-12-06 ## Text 119.03 (A) Definitions of terms used for billing private duty nursing services (PDN) rates set forth in appendix A to this rule are: (1) "Base rate," as used in this rule and appendix A to this rule, means the amount reimbursed by Ohio medicaid for the initial thirty-five to sixty minutes of service delivered. (2) "Unit rate," as used in this rule and appendix A to this rule, means the amount reimbursed by Ohio medicaid for each fifteen minute units of service delivered when the initial visit is: (a) Greater than sixty minutes in length; or (b) Less than or equal to thirty-four minutes in length. (B) PDN services are delivered and billed as PDN visits in accordance with rules 5160-12-02 , 5160-12-2.3 and 5160-12-04 of the Administrative Code. The services will be provided by medicare certified home health agencies, "otherwise accredited agencies," or "non-agency nurses." PDN service rates are identified in appendix A to this rule. (C) The amount of reimbursement for a PDN visit will be the lesser of the provider's billed charge or the medicaid maximum rate. The medicaid maximum rate is determined by using a combination of the base rate and unit rate found in appendix A to this rule using the number of units of service that were provided during a visit in accordance with this chapter. (D) The amount of reimbursement for a PDN visit will be the lesser of the provider's billed charge or seventy-five per cent of the total medicaid maximum as specified in paragraph (C) of this rule when billing with the modifier HQ "group setting" for group visits conducted in accordance with rule 5160-12-04 of the Administrative Code. (E) The modifiers set forth in appendix B to this rule will be used to provide additional information in accordance with this chapter. A visit made for the purpose of home infusion therapy in accordance with 5160-12-02 of the Administrative Code will be billed using the U1 modifier modifier HQ "group setting" for group visits conducted in accordance with rule 5160-12-04 of the Administrative Code. (E) The modifiers set forth in appendix B to this rule will be used to provide additional information in accordance with this chapter. A visit made for the purpose of home infusion therapy in accordance with 5160-12-02 of the Administrative Code will be billed using the U1 modifier. (F) A visit conducted by a registered nurse (RN) for the provision of PDN servcies will be billed to Ohio medicaid using the TD modifier. A visit conducted by a licensed practical nurse (LPN) for the provision of PDN services will be billed to Ohio medicaid using the TE modifier. (G) Providers of PDN will not be reimbursed for PDN services provided to an individual that duplicate services already paid by medicaid or another funding source. For example, if the facility/home where a residential state supplemental recipient or individual receiving medicaid resides, such as an adult foster home, adult family home, adult group home, residential care facility, or other facility is paid to provide nursing services, PDN services are not reimbursable by medicaid. (H) Providers of PDN may be reimbursed for PDN services provided to an individual who resides in a facility/home if the provider has written documentation from a facility/home stating that the facility/home is not responsible for providing the same or similar PDN services to the individual. (I) PDN services provided to the individual enrolled in the assisted living home and community based services waiver in accordance with rule 5160-1-60 and Chapter 173-39 of the Administrative Code do not constitute a duplication of services. View Appendix View Appendix Last updated January 2, 2024 at 9:00 AM Supplemental Information Authorized By: 5164.02 Amplifies: 5164.02 , 5164.70 1/1/2029 5/1/1987, 9/28/2006, 1/1/2017, 11/4/2021 ## Nearby sections - [Ohio Admin. Code 5160-12-01 Rule 5160-12-01. Home health services: provision requirements, coverage and service specification](https://www.frixlaw.com/law-library/statutes/STATE_OH_ADC_5160_12_01.md) - [Ohio Admin. Code 5160-12-02 Rule 5160-12-02. Private duty nursing services: provision requirements, coverage and service specification](https://www.frixlaw.com/law-library/statutes/STATE_OH_ADC_5160_12_02.md) - [Ohio Admin. Code 5160-12-02.3 Rule 5160-12-02.3. Private duty nursing: procedures for service authorization](https://www.frixlaw.com/law-library/statutes/STATE_OH_ADC_5160_12_02_3.md) - [Ohio Admin. Code 5160-12-03 Rule 5160-12-03. Medicare certified home health agencies: qualifications and requirements](https://www.frixlaw.com/law-library/statutes/STATE_OH_ADC_5160_12_03.md) - [Ohio Admin. Code 5160-12-03.1 Rule 5160-12-03.1. Non-agency nurses and otherwise-accredited agencies: qualifications and requirements](https://www.frixlaw.com/law-library/statutes/STATE_OH_ADC_5160_12_03_1.md) - [Ohio Admin. Code 5160-12-04 Rule 5160-12-04. Home health and private duty nursing: visit policy](https://www.frixlaw.com/law-library/statutes/STATE_OH_ADC_5160_12_04.md) - [Ohio Admin. Code 5160-12-05 Rule 5160-12-05. Reimbursement: home health services](https://www.frixlaw.com/law-library/statutes/STATE_OH_ADC_5160_12_05.md) - [Ohio Admin. Code 5160-12-06 Rule 5160-12-06. Reimbursement: private duty nursing services](https://www.frixlaw.com/law-library/statutes/STATE_OH_ADC_5160_12_06.md) - [Ohio Admin. Code 5160-12-07 Rule 5160-12-07. Reimbursement: exceptions](https://www.frixlaw.com/law-library/statutes/STATE_OH_ADC_5160_12_07.md) - [Ohio Admin. Code 5160-12-08 Rule 5160-12-08. Registered nurse assessment and registered nurse consultation services](https://www.frixlaw.com/law-library/statutes/STATE_OH_ADC_5160_12_08.md) --- Source: Frix Law Library, https://www.frixlaw.com/law-library/statutes/STATE_OH_ADC_5160_12_06. Check the current official text before relying on it. Not legal advice.