These medical policies apply to our Ohio Medicaid plan.
Medical policies offer guidance on determination of medical necessity and appropriateness of care for approved benefits. Benefit determinations and coverage decisions are subject to all the terms and conditions of CareSource including eligibility, definitions, specific inclusions or exclusions, and applicable state or federal laws.
The medical policies do not constitute medical advice or medical care. Treating health care providers are solely responsible for diagnosis, treatment and medical advice. CareSource is not responsible for, does not provide, and does not represent itself as a provider of medical care.
Existing clinical policies are regularly reviewed and updated. New policies are added as appropriate while previous versions are maintained in the policy archive. These policy changes are maintained on this site.
The policies below are in PDF format. If you do not have Adobe Acrobat Reader, you may download it here.
Current Medical Policies
- Acute In-Patient Detoxification (Opioid) Prior Authorization Criteria
- Applied Behavior Analysis (ABA)
- Breast Imaging
- Breast Pumps and Lactation Services
- Breast Reconstruction Surgery Following Mastectomy
- Breast Reduction Surgery
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- Electrodiagnostic Testing: Nerve Conduction and Needle Electromyography Automated Nerve Conduction Studies
- Emergency Response Systems
- Epidural Steroid Injections (Interlaminar, Transforaminal or Caudal Epidural Injections)
- Erectile Dysfunction
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- Implantable Pain Pumps
- Implantable Spinal Cord Stimulator (SCS) Devices
- Insulin Infusion Pump Therapy for Diabetes
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- Sacroiliac Joint Injection
- Screening and Surveillance for Colorectal Cancer
- Serum Biomarker Panel Testing in Systemic Lupus Erythematosus and Rheumatoid Arthritis