MedicaidCoverageHigh impact
[Ohio] SUD Residential Services Payment Guidance
CareSource·OH · Psychiatry·Claims & Billing
We identified it
Aug 15, 2026
Summary
CareSource (Ohio Medicaid and MyCare Ohio HMO D-SNP) has issued a reminder that SUD residential treatment services are billed as all-inclusive per-diem rates with NO separate reimbursement for assessments, psychotherapy, counseling, care management, crisis intervention, peer recovery services, or urine drug screens. Providers must use approved HCPCS/CPT codes from the behavioral health fee schedule, follow ASAM LOC criteria and OAC guidelines, and ensure medical necessity documentation per OAC 5160-1-27 and 5160-8-05. Claims submitted outside these guidelines are subject to recovery.
Action Required
Immediately: Billing team must audit all current and pending SUD residential treatment claims to ensure (1) only approved HCPCS/CPT codes from CareSource's behavioral health fee schedule are being billed; (2) NO separate line items are submitted for assessments, crisis intervention, psychotherapy, counseling, care management/care coordination, therapeutic behavioral services, community psychiatric supportive treatment, peer recovery services, or point-of-care urine drug screens—these must be included in the residential per-diem; (3) members are not billed for overlapping levels of care simultaneously; (4) medical records contain documentation of ASAM LOC medical necessity per OAC guidelines. By end of business week: Contact CareSource Behavioral Health Provider Relations (CareSource_OH_BH@CareSource.com or 1-800-488-0134) to obtain the current behavioral health fee schedule with approved codes if not already on file. Update billing software compliance rules to prevent submission of bundled services as separate charges. Review with clinical documentation team to ensure all charts contain ASAM LOC justification. Failure to comply may result in claim denials and recovery demands from CareSource.