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[Ohio] Behavioral Health Service Frequency Guidelines
Act
by Jun 30, 2026
Effective date
Jul 1, 2026
Identified
May 30, 2026
Summary
Effective July 1, 2026, CareSource Ohio Next Generation MyCare & Medicaid is implementing new service frequency thresholds for behavioral health services. Prior authorization will be required once members exceed specified unit/day limits for withdrawal management, intensive outpatient programs, psychiatric support, and therapeutic services. Billing teams must track member utilization across all providers and obtain prior auth before services exceed thresholds to avoid claim denials.
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What to do
by Jun 30, 2026 · 7 steps
01Billing team must implement tracking system to monitor member utilization for all behavioral health codes (H0010, H0011, H0012, H0014, H0015, H0036, H2017, H2019, H2020) across the calendar year.
02Configure billing software to automatically flag and require prior authorization when thresholds are met: H0010/H0011/H0012/H0014 after 7 consecutive days; H0015/H2020 at 30 units per calendar year; H0036 at 200 units (50 hours) individual or 120 units (30 hours) group per calendar year; H2017/H2019 at 200 units (50 hours) combined or 120 units (30 hours) group per calendar year.
03Register all billing and clinical staff in the CareSource Provider Portal to access real-time member utilization reports.
04Update clinical protocols to require providers to verify member's total utilization from all providers before rendering services.
05Establish internal workflow requiring prior authorization submission with 7-day turnaround expectation for most services and 48-hour turnaround for withdrawal management codes.
06Failure to obtain prior authorization before service thresholds are exceeded will result in claim denials.
07Utilization prior to July 1, 2026 will not count toward new thresholds.
Codes mentioned
H0010H0011H0012H0014H0015H0036H2017H2019H2020
Original notice
[Ohio] Behavioral Health Service Frequency Guidelines
caresource.com · Always check the source before changing claims.
Related changes
See all CareSource changes →[Ohio] Community Behavioral Health BillingHighEffective Sep 4, 2025 · Claims & Billing[Georgia] CareSource Policy and Prior Authorization changesHighEffective Jan 1, 2026 · Medical Policy[Ohio] Same‑Day Billing Limits for Per Diem Behavioral Health ServicesHighEffective Aug 24, 2026 · Claims & Billing[Georgia] Prior Authorization Requirement UpdateHighEffective Jul 10, 2025 · Provider BulletinBrowse every CareSource change in the policy list