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CareSourceMedicaid · Billing Codes · Coding · OH · Psychiatry, Family Medicine, Internal Medicine +2 moreHigh impact

[Ohio] Evaluation and Management (E/M) and Psychotherapy Add-On Billing Policy

Act
by Aug 31, 2026
Effective date
Sep 1, 2026
Identified
Jul 18, 2026

Summary

CareSource Ohio Medicaid is implementing strict concurrent billing restrictions on psychotherapy add-on codes (90833, 90836, 90838) with high-level E/M services (99204, 99205, 99214, 99215). When billed together on the same date by the same provider, psychotherapy add-ons will be denied and only the E/M will be reimbursed. Providers must now document separate start/stop times, non-overlapping clinical effort, and ensure E/M levels are based on medical decision-making rather than time when billing these combinations.

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What to do

by Aug 31, 2026 · 6 steps
01Billing team must update billing system to flag and prevent automatic submission of claims combining psychotherapy add-on codes (90833, 90836, 90838) with E/M codes (99204, 99205, 99214, 99215) on the same date/provider TIN for CareSource Ohio Medicaid members without documented approval.
02Providers must begin documenting start and stop times for both E/M and psychotherapy services on all encounters where these codes may be used together.
03Providers must document that psychotherapy and E/M services are substantially and independently identifiable with no overlapping time or clinical effort.
04Providers must base E/M level selection on medical decision-making complexity alone, not total encounter time, when add-on psychotherapy is billed.
05Front desk and clinical staff must be trained that prolonged services codes cannot be reported with these psychotherapy add-on combinations.
06Update encounter templates/EMR to require separate documentation of psychotherapy interventions (symptom reduction, behavior modification, functional support) distinct from E/M medical decision-making.
If missed: Failure to comply will result in claim denials for the psychotherapy add-on component and potential audit/compliance issues.

Codes mentioned

90833908369083899204992059921499215

Original notice

[Ohio] Evaluation and Management (E/M) and Psychotherapy Add-On Billing Policy
caresource.com · Always check the source before changing claims.
View original ↗

Related policy hubs

CareSource policiesOH policy changesPsychiatryFamily MedicineInternal MedicineGeneral PracticePediatricsCode 90833Code 90836Code 90838Code 99204Code 99205Code 99214Code 99215

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

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