MedicaidCoverageMedium impact
[Ohio] Non-Covered Professional Radiology Services
CareSource·OH · Radiology, Nuclear Medicine·Provider Bulletin
Effective date
Jun 15, 2025
We identified it
May 9, 2026
Summary
CareSource Ohio Medicaid is implementing new claims editing logic effective June 15, 2025, to deny six professional radiology service codes that are now classified as non-covered services per Ohio Department of Medicaid guidelines. Billing teams must identify and stop billing these codes or face automatic claim denials.
Action Required
By June 15, 2025: Billing team must update billing system to flag and block submission of CPT codes 76140, 76948, 77061, 77062, 78351, and 78609 for all CareSource Ohio Medicaid claims. Review and update all encounter templates, charge masters, and standing orders used by radiology providers to remove these codes from default selections. Notify all radiology providers and ordering physicians of the non-covered status. Establish a process to identify any pending or in-process claims with these codes and deny or resubmit appropriately before the effective date. Claims submitted on or after June 15, 2025 with these codes will be automatically denied by CareSource. Contact CareSource Provider Services at 1-800-488-0134 (Monday-Friday, 7am-8pm ET) with questions.