MedicaidAdministrativeMedium impact
[Ohio] Policy Updates February 2025
CareSource·OH · Pain Management, Physical Therapy·Medical Policy
Effective date
Apr 1, 2025
We identified it
May 9, 2026
Summary
CareSource Ohio Medicaid released three policy updates effective April 1, 2025: revisions to Bilateral Procedures (AD-1055), a new Laboratory Testing in Office Setting policy (PY-1545), and a revision to Transcutaneous Electrical Nerve Stimulators (PY-0039). The document provides notice of these changes but does not include detailed policy content, requiring providers to access the full policies online to understand specific billing and prior authorization impacts.
Action Required
By March 31, 2025: Billing team must access the full policy text for each of the three updated policies on CareSource.com (Providers > Tools & Resources > Provider Policies > Ohio Medicaid) to determine specific impacts: (1) Review AD-1055 Bilateral Procedures revision for any changes to prior authorization requirements or billing rules; (2) Review new PY-1545 Laboratory Testing in Office Setting policy to understand coverage, coding, and reimbursement requirements for in-office lab services; (3) Review PY-0039 TENS revision for changes to coverage or prior authorization. Update billing system rules, encounter forms, and staff training accordingly. Claims submitted after April 1, 2025 that do not comply with the updated policies may be denied or subject to recoupment.