MedicaidCoverageMedium impact
[Ohio] Policy Updates October 2025
CareSource·OH · Ophthalmology, Gastroenterology, Pulmonology·Medical Policy
Effective date
Dec 1, 2025
We identified it
May 9, 2026
Summary
CareSource Ohio Medicaid released three medical policy updates effective December 1, 2025: one new policy for Digital Therapy Devices treating amblyopia (MM-1841) and two revised policies for Peroral Endoscopic Myotomy (MM-1245) and Positive Airway Pressure Device rental (MM-1019). This is a network notification consolidating monthly policy updates; billing teams must review the full policy documents to identify specific coding, coverage, or prior authorization changes.
Action Required
By November 28, 2025: Billing team must access CareSource.com > Providers > Tools & Resources > Provider Policies, select Ohio Medicaid, and review the full text of all three policies (MM-1841, MM-1245, MM-1019). Document any changes to: (1) covered/non-covered services, (2) prior authorization requirements, (3) billing codes, or (4) medical necessity documentation. Update billing system rules, encounter forms, and provider alerts accordingly before December 1, 2025 effective date. This notification does not contain specific codes—full policies must be reviewed to identify impact. Failure to implement changes may result in claim denials or payment delays starting December 1, 2025.