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Ohio Medicaid 

Payment Policies

Payment policies are designed to assist you when submitting claims to CareSource. They are routinely updated to promote accurate coding and policy clarification. These proprietary policies are not a guarantee of payment. Payments for claims may be subject to limitations and/or qualifications. Payment will be determined based upon a review of the actual services provided to a member and will be determined when the claim is received for processing. Providers and their office staff are encouraged to use self-service channels to verify member’s eligibility.

The policies below are in PDF format. If you do not have Adobe Acrobat Reader, you may download it here.

Current Payment Policies

PolicyEffective Date
Abortion
Acupuncture Services
Advanced Diagnostic Imaging Services
Allergy Testing and Allergen Immunotherapy
Anesthesia
Antigen Leukocyte Cellular Antibody Testing ("ALCAT")
Behavioral Health Professional Billing Policy
Bilateral Procedures
Blood Specimen Collection Fee (Venipuncture)
Chiropractic Care
Colonoscopies
Corneal Tissue Replacement at Free-standing Surgical Centers
CPT Codes Not Covered in an Emergency Room Setting
Drug Screening Tests-OH Medicaid
Dry Eye Syndrome Testing
Durable Medical Equipment and Modifiers
Emergency Department EKG and Imaging Interpretation
Family Planning
Free Standing Ambulatory Surgical Centers Claims for CPT Code 41899
Genetic Testing – Polymerase Chain Reaction
Healthcare Acquired Conditions, Provider Preventable Conditions and Conditions Present on Admission
Hysterectomy
Imaging Services
Mammography Services
Medication Assisted Therapy
Nursery and Psychiatric Hospital Levels
Observation Care
Occupational, Physical, & Speech Therapy
Outpatient Hospital Surgical Non Grouped Codes
Oxygen Delivery Systems & Supplies
Pain Management
Pass-Through Billing
Post Stabilization Care Services
Preventive Services and Sick Visit on Same Date of Service
Provider Issue Resolution Process
Psychiatric Day Programs
Sexually Transmitted Infections
Skilled Nursing Facilities - MyCare Ohio
Sterilization
Transcutaneous Electrical Nerve Stimulators (“TENS”)
Unlisted Surgical Procedures for Outpatient Claims
Vaccination and Immunization Services

Archived Payment Policies