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CareSourceMedicaid · Prior Auth · Provider Bulletin · OH · Orthopedics, Wound Care, PM&R (Physical Medicine & Rehab)High impact

[Ohio] Prior Authorization Requirement Update

Effective date
Jan 1, 2026
Identified
Jun 13, 2026

Summary

CareSource Ohio Medicaid will require prior authorization for 110+ newly added quarterly codes effective January 1, 2026. The codes include laboratory tests (U codes), medical supplies (A codes), DME equipment (E codes), orthotics/prosthetics (L codes), and skin substitutes (Q codes).

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What to do

Action · 5 steps
01Before January 1, 2026: Billing team must update prior authorization system to require approval for all 110+ listed codes for CareSource Ohio Medicaid patients.
02Update billing software rules and add flags to encounter forms.
03Verify member eligibility and obtain prior auth before services.
04Use CareSource Procedure Lookup Tool to check requirements.
05Claims will be denied without proper prior authorization.

Codes mentioned

A2030A2031A2032A2033A2034A2035A6515A6516A6517A6518A6519A6611C8005E0201E1022E1023E1032E1033E1034E1832L0720L1933L1952L5827L6028L6029L6030L6031L6032L6033L6037L6700L7406Q4354Q4355Q4356Q4357Q4358Q4359Q4360Q4361Q4362Q4363Q4364Q4365Q4366Q4367S4024Q4368Q4369Q4370Q4371Q4372Q4373Q4375Q4376Q4377Q4378Q4379Q4380Q4381Q4382

Original notice

[Ohio] Prior Authorization Requirement Update
caresource.com · Always check the source before changing claims.
View original ↗

Related changes

See all CareSource changes →
[Georgia] Prior Authorization Requirement UpdateHighEffective Jan 1, 2026 · Provider Bulletin[Georgia] Prior Authorization Requirement UpdateHighEffective Jan 1, 2026 · Provider Bulletin[Ohio] Prior Authorization Requirement UpdateMediumNo effective date · Provider Bulletin[Ohio] Prior Authorization Requirement UpdateMediumEffective May 4, 2026 · Provider BulletinBrowse every CareSource change in the policy list

Related policy hubs

CareSource policiesOH policy changesOrthopedicsWound CarePM&R (Physical Medicine & Rehab)Code A2030Code A2031Code A2032Code A2033Code A2034Code A2035Code A6515Code A6516Code A6517Code A6518Code A6519Code A6611Code C8005Code E0201Code E1022Code E1023Code E1032Code E1033Code E1034Code E1832Code L0720Code L1933Code L1952Code L5827Code L6028Code L6029Code L6030Code L6031Code L6032Code L6033Code L6037Code L6700Code L7406Code Q4354Code Q4355Code Q4356Code Q4357Code Q4358Code Q4359Code Q4360Code Q4361Code Q4362Code Q4363Code Q4364Code Q4365Code Q4366Code Q4367Code S4024Code Q4368Code Q4369Code Q4370Code Q4371Code Q4372Code Q4373Code Q4375Code Q4376Code Q4377Code Q4378Code Q4379Code Q4380Code Q4381Code Q4382

Summaries are AI-assisted. Always confirm against the original payer notice.

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