MedicaidAdministrativeHigh impact
[Ohio] June 2026 Policy Updates
CareSource·OH · Gastroenterology, Psychiatry·Medical Policy
Effective date
Jul 1, 2026
We identified it
Jun 6, 2026
Summary
CareSource Ohio Medicaid released consolidated policy updates effective July 1, 2026 (1 new policy) and August 1, 2026 (7 revised policies). Changes affect reimbursement policies for colonoscopy/sigmoidoscopy, DME modifiers, unlisted codes, and modifier usage; administrative policies for itemized billing, medical record documentation, and provider home visits; and a new medical policy for private duty nursing. Billing teams must review each policy on the CareSource website and implement changes by the effective dates to avoid claim denials.
Action Required
By June 30, 2026: Billing team must access CareSource.com > Providers > Tools & Resources > Provider Policies, select Ohio Medicaid plan, and review all 8 updated/new policies (PY-1592, PY-0022, AD-0857, AD-0753, PY-1345, PY-1456, MM-1510, AD-1165, PY-1748). For each policy, identify specific billing code changes, documentation requirements, and modifier rules. Update billing software, encounter forms, and provider education materials accordingly. Effective July 1, 2026: Implement Community Behavioral Health Services Utilization Management changes (PY-1748). Effective August 1, 2026: Implement all remaining 7 policy changes. Notify clinical and administrative staff of new requirements. Document all changes in compliance files. Failure to implement will result in claim denials and possible audit issues.