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[Ohio] Community Behavioral Health Billing
Act
immediately
Effective date
Sep 4, 2025
Identified
May 9, 2026
Summary
CareSource Ohio Medicaid is reminding Community Behavioral Health providers (group types 84/95) of critical billing rules to prevent denials. Key restrictions include: mental health and substance use disorder codes must be billed under correct specialty NPIs; H0005 is limited to 4 units when billed with H0015 on the same date; and four specific group therapy codes are limited to 4 units (1 hour) per day when billed together unless prior authorized.
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What to do
immediately · 11 steps
01Billing team must implement unit limits in billing system for behavioral health claims:
1. Enforce that H0005 cannot exceed 4 units on the same date of service as H0015 (IOP/PHP).
02Configure system to deny or flag claims violating this limit.
032. Enforce that codes 90853, H2020, H2012, H2019 (with HQ modifier), and H0036 (with HQ modifier) cannot collectively exceed 4 units (1 hour) per day when billed on the same date of service unless prior authorization is present.
04Update claim validation rules.
053. Audit current billing workflows to ensure mental health and substance use disorder codes are submitted under correct billing group NPIs matching provider specialty in Provider Master File (PMF).
06Update provider roster/credentialing files if necessary.
074. Verify that all practitioner specialty codes and active dates of service in billing system match PMF data.
08Billing team must reconcile provider records with CareSource within 30 days.
095. Providers and clinical staff must ensure medical records document medical necessity per Ohio Administrative Code rules 5160-1-27 and 5160-8-05 for all billed services.
10Consequences: Claims violating unit limits or submitted under incorrect NPIs/specialties will be denied.
11Contact CareSource Provider Services (1-800-488-0134 or CareSource_OH_BH@CareSource.com) for prior authorization requests or clarification.
Codes mentioned
H0015H000590853H2020H2012H2019H0036
Original notice
[Ohio] Community Behavioral Health Billing
caresource.com · Always check the source before changing claims.
Related changes
See all CareSource changes →[Ohio] Behavioral Health Service Frequency GuidelinesHighEffective Jul 1, 2026 · Specialty Services[Ohio] Same‑Day Billing Limits for Per Diem Behavioral Health ServicesHighEffective Aug 24, 2026 · Claims & Billing[Georgia] CareSource Policy and Prior Authorization changesHighEffective Jan 1, 2026 · Medical Policy[Georgia] Prior Authorization Requirement UpdateHighEffective Jul 10, 2025 · Provider BulletinBrowse every CareSource change in the policy list