MedicaidReimbursementHigh impact
5160-19-04 - Episode based payments. (Rescind/Final File)
Ohio Medicaid·OH·Medical Policy
Effective date
Jan 1, 2024
We identified it
Jun 20, 2026
Summary
Ohio Medicaid has rescinded Rule 5160-19-04 governing episode-based payments, effective January 1, 2024. This removes the regulatory framework for bundled payment arrangements under Ohio Medicaid, reverting to standard fee-for-service billing.
Action Required
Effective January 1, 2024: Billing teams in Ohio must discontinue any episode-based payment billing arrangements with Ohio Medicaid and revert to standard fee-for-service billing for all affected services. Update billing software to remove episode-based payment rules and ensure all Ohio Medicaid claims are processed using individual CPT/HCPCS codes rather than bundled payments.