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CareSourceMedicaid · Billing Codes · Provider Bulletin · OH · OB-GYN, Family MedicineMedium impact

[Ohio] Group Pregnancy Education

Act
by Jun 15, 2025
Effective date
Jun 15, 2025
Identified
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.

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What to do

by Jun 15, 2025 · 3 steps
01Billing team must update billing system logic to enforce same-date-of-service requirement for CPT 99078 when paired with prenatal evaluation and management services.
02Providers must document and bill group pregnancy education only on dates when prenatal evaluation and management services are also provided.
03Update encounter templates and superbills to alert providers to this requirement.
If missed: Failure to comply will result in claim denials from CareSource Ohio Medicaid.

Codes mentioned

99078

Original notice

[Ohio] Group Pregnancy Education
caresource.com · Always check the source before changing claims.
View original ↗

Related policy hubs

CareSource policiesOH policy changesOB-GYNFamily MedicineCode 99078

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

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