MedicaidReimbursementHigh impact
[Ohio] OAC 5160-13-08, Add-On Payment for Nursing Facility-Based Hemodialysis Furnished by a Dialysis Center
CareSource·OH · Nephrology·Claims & Billing
Effective date
Jul 1, 2026
We identified it
Jul 2, 2026
Summary
Ohio Medicaid (CareSource) is implementing a new $110 per-treatment add-on payment for nursing facility-based hemodialysis services furnished by dialysis centers, effective July 1, 2026. Dialysis centers must bill using a designated HD revenue center code with an ODM-specified modifier to claim this add-on. The program is subject to a $2.1 million state budget cap and applies only during State Fiscal Year 2027 for dialysis centers already providing these services.
Action Required
By July 1, 2026: Billing team must (1) obtain the ODM-specified modifier and designated HD revenue center code from CareSource's PNM Quick Reference Guide; (2) update billing software to append the modifier when billing nursing facility-based HD claims; (3) implement tracking to confirm service dates fall within SFY 2027 (July 1, 2026–June 30, 2027); (4) monitor total add-on payments against the $2.1M budget cap and stop billing once exhausted; (5) flag and discontinue add-on payments for dual Medicare/Medicaid patients once Medicare coverage begins. Providers and billing staff must verify dialysis center eligibility (providing NF-based HD on or before July 1, 2026). Failure to use correct modifier will result in claim denials or payment delays. Contact CareSource Provider Services at 1-800-488-0134 with questions.