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CareSourceMedicare Advantage · Billing Codes · Provider Bulletin · OH · Physical Therapy, Wound CareMedium impact

[Ohio] Lymphedema Compression Treatment Items Claims Editing Enhancements

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

Summary

Beginning January 15, 2026, CareSource will enhance claims editing for lymphedema compression treatment items (HCPCS codes A6520-A6610) to require appropriate lymphedema diagnosis codes and mandatory RT/LT modifiers to indicate treatment side (right or left). Bilateral billing is now permitted with proper modifier usage.

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What to do

by Jan 15, 2026 · 7 steps
01Billing team must update claims submission processes and billing software to enforce the following requirements for all lymphedema compression treatment item claims (codes A6520-A6610).
02Validate that claims include appropriate lymphedema diagnosis codes before submission.
03Require RT (right) or LT (left) modifiers on all claims to indicate treatment laterality.
04Enable bilateral claim processing to allow both sides to be billed on the same claim with appropriate modifiers.
05Update encounter forms and billing templates to prompt providers to specify diagnosis and treatment side.
06Train billing staff on the new modifier requirements.
07Verify that your billing system can accommodate bilateral claims with laterality modifiers.
If missed: Failure to include required diagnosis codes and modifiers will result in claim denials or rejections during CareSource's enhanced editing process.

Codes mentioned

A6520A6521A6522A6523A6524A6525A6526A6527A6528A6529A6530A6533A6534A6535A6536A6537A6538A6539A6540A6541A6549A6552A6553A6554A6555A6556A6557A6558A6559A6560A6561A6562A6563A6564A6565A6566A6567A6568A6569A6570A6571A6572A6573A6574A6575A6576A6577A6578A6579A6580A6581A6582A6583A6584A6585A6586A6587A6588A6589A6593A6594A6595A6596A6597A6598A6599A6600A6601A6602A6603A6604A6605A6606A6607A6608A6609A6610

Original notice

[Ohio] Lymphedema Compression Treatment Items Claims Editing Enhancements
caresource.com · Always check the source before changing claims.
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Related changes

See all CareSource changes →
[Indiana] Lymphedema Compression Treatment Items Claims Editing EnhancementsMediumEffective May 4, 2026 · Provider Bulletin[Georgia] Lymphedema Compression Treatment Items Claims Editing EnhancementsMediumEffective Feb 24, 2026 · Provider Bulletin[Ohio] Prior Authorization Requirement UpdateHighEffective Apr 1, 2025 · Provider Bulletin[Georgia] Prior Authorization Requirement UpdateMediumEffective Apr 1, 2025 · Provider BulletinBrowse every CareSource change in the policy list

Related policy hubs

CareSource policiesOH policy changesPhysical TherapyWound CareCode A6520Code A6521Code A6522Code A6523Code A6524Code A6525Code A6526Code A6527Code A6528Code A6529Code A6530Code A6533Code A6534Code A6535Code A6536Code A6537Code A6538Code A6539Code A6540Code A6541Code A6549Code A6552Code A6553Code A6554Code A6555Code A6556Code A6557Code A6558Code A6559Code A6560Code A6561Code A6562Code A6563Code A6564Code A6565Code A6566Code A6567Code A6568Code A6569Code A6570Code A6571Code A6572Code A6573Code A6574Code A6575Code A6576Code A6577Code A6578Code A6579Code A6580Code A6581Code A6582Code A6583Code A6584Code A6585Code A6586Code A6587Code A6588Code A6589Code A6593Code A6594Code A6595Code A6596Code A6597Code A6598Code A6599Code A6600Code A6601Code A6602Code A6603Code A6604Code A6605Code A6606Code A6607Code A6608Code A6609Code A6610

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