MedicaidCoverageMedium impact
[Ohio] Updates to the OAC Rule 5160-8-52 Pharmacist Services
CareSource·OH · Pharmacy·Provider Bulletin
Effective date
Jan 1, 2026
We identified it
May 9, 2026
Summary
Ohio Medicaid (CareSource) now allows separate billing and payment for pharmacist services provided in hospital settings (inpatient, outpatient, emergency department, and inpatient psychiatric facilities). The previous policy prohibiting separate payment for these services has been rescinded effective January 1, 2026. Healthcare practices can now bill pharmacist services at the individual pharmacist level or hospital facility level.
Action Required
By January 1, 2026: Billing team must review and update billing system configuration to enable separate billing for pharmacist services in hospital settings. Verify that claims submission processes allow pharmacist service codes to be billed for inpatient, outpatient, emergency department, and inpatient psychiatric facility settings. Update any internal billing guidelines or templates that previously blocked or restricted these claims. Communicate changes to providers and hospital pharmacy staff to ensure they understand the new billing opportunity. Contact CareSource Provider Services at 1-800-488-0134 (Monday-Friday, 7 a.m. to 8 p.m. ET) with questions about specific billing codes or claim submission procedures. Failure to update systems may result in missed revenue opportunities, as claims for hospital-based pharmacist services should now be reimbursed separately.