Summary
CareSource applies the Avalon laboratory policies listed in this notice on June 1, 2026 to Ohio Marketplace, Georgia Dual Special Needs (D-SNP), Georgia Marketplace, Nevada Marketplace and West Virginia Marketplace members. The policies cover routine lab testing such as cervical cancer screening, diabetes mellitus testing, hepatitis testing, tuberculosis testing and HIV testing. CareSource's routine testing management program is a post-service, pre-payment clinical claim editing program for routine lab testing that is based on compliance with the Avalon lab policies.
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What to do
Action · 4 steps
01Already effective 2026-06-01: Billing team should check lab claims for these plans against the Avalon laboratory policies listed in the notice.
02Providers may use the Trial Claim Advice tool on the CareSource Provider Portal to review claims with laboratory services for adherence and consistency with CareSource laboratory policies.
03The Trial Claim Advice tool is a simulation tool and does not guarantee approval or reimbursement of claims.
04The Avalon policies appear on the Avalon website upon their effective dates, so check the Avalon website for the current status of each policy.
Codes mentioned
G2002G2006G2007G2011G2035G2036G2043G2048G2050G2051G2059G2060G2063G2100G2105G2110G2113G2115G2119G2121G2123G2124G2149G2150G2151G2153G2154G2155G2156G2158G2159G2173G2174G2181M2057M2068M2097M2116
Original notice
[Ohio] Avalon Policy Updates Q3/Q4 2025
caresource.com · Always check the source before changing claims.
Related changes
See all CareSource changes →[Ohio] Avalon Policy UpdatesHighEffective Dec 1, 2026 · Medical Policy[Georgia] Avalon Policy Updates - Q3 2024HighEffective Apr 1, 2025 · Medical Policy[Ohio] Avalon Q3 Policy Update - February 2025HighEffective Apr 1, 2025 · Medical Policy[Georgia] Avalon Policy Updates - November 2025MediumEffective Jan 1, 2026 · Medical PolicyBrowse every CareSource change in the policy list
Related policy hubs
CareSource policiesOH policy changesGA policy changesNV policy changesWV policy changesPathologyCode G2002Code G2006Code G2007Code G2011Code G2035Code G2036Code G2043Code G2048Code G2050Code G2051Code G2059Code G2060Code G2063Code G2100Code G2105Code G2110Code G2113Code G2115Code G2119Code G2121Code G2123Code G2124Code G2149Code G2150Code G2151Code G2153Code G2154Code G2155Code G2156Code G2158Code G2159Code G2173Code G2174Code G2181Code M2057Code M2068Code M2097Code M2116