MedicaidAdministrativeMedium impact
5160-1-60.4 - By-report procedures, services, and supplies. (Amend/Final File)
Ohio Medicaid·OH·Medical Policy
Effective date
Oct 1, 2025
We identified it
Jun 20, 2026
Summary
Ohio Medicaid has amended Rule 5160-1-60.4 regarding by-report procedures, services, and supplies, with changes taking effect October 1, 2025. This amendment updates requirements for billing unlisted or unusual procedures that require manual review and pricing by the payer.
Action Required
Before October 1, 2025: Billing team must review updated Ohio Medicaid guidelines for by-report procedures and services. Update billing procedures to ensure compliance with new requirements for submitting unlisted procedures, modifier usage, and documentation standards. Contact Ohio Medicaid at 614-752-3877 for specific guidance on changes to by-report billing requirements.