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CareSourceMedicaid · Prior Auth · Provider Bulletin · OHHigh impact

[Ohio] Prior Authorization Requirement Update

Act
by Mar 31, 2025
Effective date
Apr 1, 2025
Identified
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.

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What to do

by Mar 31, 2025 · 5 steps
01Billing 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.
02Update internal billing workflows and provider documentation templates to flag these codes for prior auth submission.
03Train billing staff to verify member eligibility, medical necessity, and covered benefits before claim submission.
04Contact CareSource Provider Services at 1-800-488-0134 (Mon-Fri, 8 a.m.-6 p.m. ET) with questions.
05Claims submitted without prior authorization for these codes will be denied.

Codes mentioned

C1601Q4294Q4295E0737E2298Q4304A6523A6524A6525A6526E0468A4457A6586L1320A2027A2028A2029A4543A4544A4545A7021E0469E0721E0743E0767E2513L1006L8720L8721Q4334Q4335Q4336Q4337Q4338Q4339Q4340Q4341Q4342Q4343Q4344Q4345

Original notice

[Ohio] Prior Authorization Requirement Update
caresource.com · Always check the source before changing claims.
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Related policy hubs

CareSource policiesOH policy changesCode C1601Code Q4294Code Q4295Code E0737Code E2298Code Q4304Code A6523Code A6524Code A6525Code A6526Code E0468Code A4457Code A6586Code L1320Code A2027Code A2028Code A2029Code A4543Code A4544Code A4545Code A7021Code E0469Code E0721Code E0743Code E0767Code E2513Code L1006Code L8720Code L8721Code Q4334Code Q4335Code Q4336Code Q4337Code Q4338Code Q4339Code Q4340Code Q4341Code Q4342Code Q4343Code Q4344Code Q4345

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