Start free

PolicyChanges tracks payer policy changes for medical practices and tells you what to do before they take effect.

Create a free accountPolicy Monitoring is free. No card required.
← Back to list
CareSourceMedicare Advantage · Billing Codes · Claims & Billing · OH · Orthopedics, Physical Therapy, Occupational Therapy +3 moreHigh impact

[Ohio] Claim Edits for Durable Medical Equipment

Act
by Jan 15, 2026
Effective date
Jan 15, 2026
Identified
May 9, 2026

Summary

CareSource is implementing new claim edits for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) effective January 15, 2026, aligning with CMS payment policies. Billing teams must ensure correct use of modifiers (rental, anatomical, functional, and surgical dressing modifiers) on all DMEPOS claims to prevent denials. Key restrictions include limiting breast pumps to one unit per delivery (240 days/eight months) and applying state guidelines.

Get alerts when payers change rules like this one

We check CareSource and other payers every day and email you when a change matches your specialty and state.

Get CareSource alertsPolicy Monitoring is free. No card required.

What to do

by Jan 15, 2026 · 8 steps
01Billing team must audit and update all DMEPOS billing workflows to ensure correct modifier application.
02Update billing software to enforce use of rental modifiers (RR), anatomical modifiers (LT, RT), functional modifiers (K0-K4), surgical dressing modifiers (A1-A9, GY), and other required modifiers (KF, KX, GA, GY, GZ) based on DMEPOS item type.
03Implement system edits to allow only one breast pump code (E0602, E0603, or E0604) per patient per delivery period (240 days/eight months) across all providers.
04Review and update encounter forms and billing instructions to remind providers of correct modifier requirements.
05Train billing staff on modifier requirements for wheelchairs/accessories, hospital beds, oxygen equipment, respiratory assist devices, orthosis, orthopedic footwear, urological supplies, surgical dressings, and capped rentals.
06Apply Ohio state guidelines for DMEPOS billing.
07Failure to use correct modifiers will result in claim denials.
08Contact CareSource Provider Services with questions: D-SNP 1-833-230-2176, Marketplace 1-833-230-2101, Medicaid 1-800-488-0134, MyCare 1-800-488-0134 (M-F, hours vary by plan).

Codes mentioned

E0602E0603E0604

Original notice

[Ohio] Claim Edits for Durable Medical Equipment
caresource.com · Always check the source before changing claims.
View original ↗

Related changes

See all CareSource changes →
[Indiana] Claim Edits for Durable Medical EquipmentHighEffective Jun 10, 2026 · Claims & Billing[Georgia] Claim Edits for Durable Medical EquipmentHighEffective Jan 17, 2026 · Claims & BillingBrowse every CareSource change in the policy list

Related policy hubs

CareSource policiesOH policy changesOrthopedicsPhysical TherapyOccupational TherapyWound CareUrologyPM&R (Physical Medicine & Rehab)Code E0602Code E0603Code E0604

Summaries are AI-assisted. Always confirm against the original payer notice.

What is PolicyChanges

One workspace for payer rules, prior auth, coding and compliance

Medical practices use PolicyChanges to catch payer changes before they cause denials. Every change is summarized in plain English, with the codes involved, the date it takes effect and what to do.

Policy MonitoringPayer policy, prior auth and coding changes, filtered to your saved searchesOIG ScreeningStaff and vendors screened every month against OIG LEIE, SAM.gov and state Medicaid listsPrior Auth LookupKnow if a service needs prior authorization before you schedule itCredentialing TrackerLicenses, CAQH, Medicare revalidation and payer enrollments, with reminders before anything lapsesCompliance CenterKeep your HIPAA program documented and ready to show
Start freePolicy Monitoring is free. No card required.
Get alerts for changes like thisPolicy Monitoring is free. No card required.Create a free account