MedicaidPrior AuthHigh impact
[Ohio] Prior Authorization Requirement Update
CareSource·OH · Orthopedics, Wound Care, PM&R (Physical Medicine & Rehab)·Provider Bulletin
Effective date
Jan 1, 2026
We identified it
Jun 13, 2026
Summary
CareSource Ohio Medicaid will require prior authorization for 110+ newly added quarterly codes effective January 1, 2026. The codes include laboratory tests (U codes), medical supplies (A codes), DME equipment (E codes), orthotics/prosthetics (L codes), and skin substitutes (Q codes).
Action Required
Before January 1, 2026: Billing team must update prior authorization system to require approval for all 110+ listed codes for CareSource Ohio Medicaid patients. Update billing software rules and add flags to encounter forms. Verify member eligibility and obtain prior auth before services. Use CareSource Procedure Lookup Tool to check requirements. Claims will be denied without proper prior authorization.