MedicaidCoverageMedium impact
[Ohio] April 2026 Policy Updates
CareSource·OH · Pain Management, Bariatric Surgery, Occupational Therapy +6 more·Medical Policy
Effective date
Jun 1, 2026
We identified it
May 9, 2026
Summary
CareSource Ohio Medicaid released 10 policy updates effective June 1, 2026, including revisions to medical policies (nerve stimulators, bariatric surgery, adaptive seating, standing frames, genetic testing, mechanical stretching devices, and transcranial magnetic stimulation), one new administrative policy (speech generating devices), and two reimbursement policy revisions (modifier 26/TC components and dental procedures in facility settings). Billing teams must review each linked policy for specific coverage, documentation, and billing requirements before the effective date.
Action Required
By May 31, 2026: Billing team must access each of the 10 revised/new policies via CareSource.com > Providers > Tools & Resources > Provider Policies, select Ohio Medicaid plan, and review full policy text for: (1) coverage criteria changes, (2) prior authorization requirements, (3) billing code updates, and (4) documentation requirements. Update billing software, encounter forms, and prior authorization workflows accordingly for: Peripheral Nerve Stimulators (MM-1333), Metabolic/Bariatric Surgery (MM-1061), Adaptive Seating (MM-1718), Speech Generating Devices (AD-1621), Modifier 26/TC Reimbursement (PY-1474), Standing Frames (MM-1331), Genetic Testing (MM-0003), Mechanical Stretching Devices (MM-1225), Transcranial Magnetic Stimulation (MM-0233), and Dental Procedures in ASC/Hospital (PY-1244). Claims submitted without compliance to revised policies will be subject to denial or recoupment. Assign policy review to relevant department leads (e.g., surgery billing for bariatric, behavioral health for TMS, therapy for adaptive equipment).