MedicaidBilling CodesMedium impact
[Ohio] Group Pregnancy Education
CareSource·OH · OB-GYN, Family 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, requiring that CPT 99078 (Group Pregnancy Education) be billed on the same date of service as a prenatal evaluation and management service to align with Ohio State Medicaid Guidelines. Claims that do not meet this requirement will be subject to denial.
Action Required
By June 15, 2025: Billing team must update billing system logic to enforce same-date-of-service requirement for CPT 99078 when paired with prenatal evaluation and management services. Providers must document and bill group pregnancy education only on dates when prenatal evaluation and management services are also provided. Update encounter templates and superbills to alert providers to this requirement. Failure to comply will result in claim denials from CareSource Ohio Medicaid.