MedicaidCoverageHigh impact
[Ohio] July 2026 Policy Updates
CareSource·OH · Psychiatry, Pediatrics, Physical Therapy +5 more·Medical Policy
Effective date
Sep 1, 2026
We identified it
Jul 1, 2026
Summary
CareSource Ohio Medicaid released 12 policy updates effective September 1, 2026 and October 1, 2026, including new reimbursement policies for Applied Behavior Analysis, EKG Interpretations, E/M and Psychotherapy, and dental anesthesia services, plus revisions to existing medical and administrative policies. Billing teams must review each policy individually on the CareSource website to identify specific code changes, documentation requirements, and billing rule updates before the effective dates.
Action Required
By August 15, 2026: Billing team must access each of the 12 policies listed on CareSource.com (Providers > Tools & Resources > Provider Policies) and document specific CPT, HCPCS, and ICD-10 codes affected, prior authorization requirements, and any documentation changes. Update billing software, encounter forms, and staff workflows accordingly. Create a provider alert summarizing changes to Applied Behavior Analysis (MM-0028, PY-1638), EKG Interpretations (PY-1810), E/M and Psychotherapy (PY-1769), Functional Electrical Stimulation (MM-1867), and dental anesthesia (PY-1593) given their high-impact nature. For the October 1, 2026 E/M codes policy (PY-1824), establish a separate implementation timeline. Failure to implement changes by effective dates will result in claim denials or payment delays.