MedicaidAdministrativeMedium impact
[Ohio] Policy Updates March 2025
CareSource·OH · Pain Management, Orthopedics, General Surgery +8 more·Medical Policy
Effective date
May 1, 2025
We identified it
May 9, 2026
Summary
CareSource Ohio Medicaid released a consolidated policy update package effective May 1, 2025, containing 13 policy revisions and 1 new policy across medical, reimbursement, and administrative categories. The billing team must review each affected policy on CareSource.com to identify specific coding, prior authorization, and documentation requirements for their practice's service lines.
Action Required
By April 15, 2025: Billing team must access CareSource.com > Providers > Tools & Resources > Provider Policies and download the full text for each of the 13 revised policies and 1 new policy listed in this notification. For each policy affecting your practice's services, identify: (1) whether prior authorization is now required (column indicates which policies are impacted), (2) any new CPT/HCPCS billing codes or code restrictions, and (3) updated medical necessity documentation requirements. Update billing software rules, encounter forms, and provider training materials accordingly. Key policies to prioritize: Adaptive Seating for Special Needs (NEW policy—verify coverage criteria), Epidural Steroid Injections (prior auth status), Home Health Services (revised—verify authorization pathway), and Obstetrical Care–Unbundled Cost (reimbursement changes). Notify all providers of changes by April 20, 2025. Failure to implement updates by May 1, 2025, will result in claim processing delays or denials for non-compliance with new prior authorization requirements.