MedicaidPrior AuthHigh impact
[Ohio] Prior Authorization Requirement Update
CareSource·OH·Provider Bulletin
Effective date
Apr 1, 2025
We identified it
May 9, 2026
Summary
CareSource (Ohio Medicaid) is adding 41 new HCPCS and CPT codes to its prior authorization requirement list effective April 1, 2025. These codes cover various medical supplies, equipment, and devices released by CMS in 2024. All billing for these codes to CareSource Ohio Medicaid must now include prior authorization or claims will be denied.
Action Required
By March 31, 2025: Billing team must update the billing system to require prior authorization for all 41 HCPCS/CPT codes listed in this policy before submitting claims to CareSource Ohio Medicaid. Update internal billing workflows and provider documentation templates to flag these codes for prior auth submission. Train billing staff to verify member eligibility, medical necessity, and covered benefits before claim submission. Contact CareSource Provider Services at 1-800-488-0134 (Mon-Fri, 8 a.m.-6 p.m. ET) with questions. Claims submitted without prior authorization for these codes will be denied.