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[Ohio] Policy Updates March 2026

CareSource·OH · OB-GYN, General Surgery, Pain Management +2 more·Medical Policy
Effective date
May 1, 2026
We identified it
May 9, 2026
Days to comply
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Summary

CareSource Ohio Medicaid released a consolidated policy update notice for March 2026 containing 13 policy changes effective May 1, 2026. The updates span medical policies (breast reconstruction/reduction surgery, nerve blocks, trigger point injections, facet joint interventions, radiofrequency ablation), reimbursement policies (point of care testing, acupuncture, doula services, obstetrical care), and administrative policies (EKG interpretation, experimental/investigational services). Billing teams must review each individual policy document to identify specific code changes, coverage modifications, and documentation requirements.

Action Required

Action needed
REQUIREMENTS: - By April 15, 2026: Billing team must access each of the 13 revised policies listed in this notice via CareSource.com > Providers > Tools & Resources > Provider Policies to identify specific billing code changes, prior authorization requirements, and documentation updates. - Before May 1, 2026: Update billing system configuration, encounter templates, and prior authorization rules based on individual policy review. Specific actions depend on policy-by-policy review of: (1) Point of Care Testing PY-1617 (new policy), (2) Peripheral Nerve Blocks MM-1230, (3) Interest Payment PY-1324, (4) Trigger Point Injections MM-0011, (5) EKG/ECG Interpretation AD-1084, (6) Acupuncture Services PY-0152, (7) Experimental/Investigational Services AD-0006, (8) Breast Reconstruction Surgery MM-0001, (9) Obstetrical Care for Freestanding Birthing Centers PY-0939, (10) Facet Joint Interventions MM-0967, (11) Breast Reduction Surgery MM-0020, (12) Radiofrequency/Microwave Ablation MM-1349, (13) Doula Services PY-1591. - Providers and billing staff should document all changes and communicate with front desk/scheduling staff regarding any prior authorization workflow modifications. - Failure to implement required changes by May 1, 2026 may result in claim denials for affected services.

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