MedicaidBilling CodesMedium impact
[Ohio] Prothesis and Orthosis Claims Editing Logic
CareSource·OH · Orthopedics, Physical Therapy, PM&R (Physical Medicine & Rehab)·Provider Bulletin
Effective date
Jul 9, 2025
We identified it
May 9, 2026
Summary
Effective July 9, 2025, CareSource Medicaid and MyCare in Ohio will implement new claims editing logic requiring prosthetics and orthotics that can be billed bilaterally to be submitted with appropriate anatomic modifiers (LT for left, RT for right). Billing teams must update their submission practices to include these modifiers or claims will be subject to editing/denial.
Action Required
By July 9, 2025: Billing team must update claim submission procedures to require anatomic modifiers (LT and RT) on all bilateral prosthetics and orthotics claims for Ohio CareSource Medicaid and MyCare plans. Update billing software editing rules to automatically append appropriate modifiers based on laterality. Educate providers to document left vs. right anatomy on prosthetic/orthotic orders. Failure to include required modifiers will result in claims being edited or denied by CareSource.