MedicaidPrior AuthMedium impact
[Ohio] Prior Authorization Requirement Update
CareSource·OH · PM&R (Physical Medicine & Rehab), Wound Care, Orthopedics +1 more·Provider Bulletin
Effective date
May 4, 2026
We identified it
Jun 13, 2026
Summary
CareSource Ohio Medicaid is implementing prior authorization requirements for 35 new procedure codes effective May 4, 2026. These codes include durable medical equipment (E codes), prosthetics/orthotics (L codes), wound care products (Q4 codes), and laboratory tests (U codes).
Action Required
Before May 4, 2026: Billing team must update billing system to require prior authorization for all 35 listed codes for CareSource Ohio Medicaid members. Update encounter forms and EMR templates to flag these codes. Use CareSource Procedure Lookup Tool to verify requirements. Claims will be denied without proper authorization.