Ohio
highOH Schedules AND Rates
Run Date and Time
Apr 01, 2026
5m 51s
Run Metrics
Fee Schedule Impacts
Run summary
This run for Ohio Department of Medicaid Fee Schedule and Rates / OH_SCHEDULES_AND_RATES identified 0 changed documents and 29 newly discovered documents. 27 item(s) are high priority. 9 newly discovered item(s) appear current or upcoming. 53 fetch error(s) occurred.
High Impact (27)
CPT-HCPCS-2024-01-01.xlsx
The document outlines changes to CPT/HCPCS codes effective January 1, 2024, including updates to surgery, medicine, radiology, and evaluation and management services. It specifies new and revised maximum payment amounts and introduces genomic sequence analysis codes.
Highlights
- •Effective date: January 1, 2024
- •Changes to surgery, medicine, radiology, and E&M services
- •New genomic sequence analysis codes: 81462, 81463, 81464
- •Status codes indicate initial or changed payment amounts
Reason
The document includes reimbursement-impacting changes effective soon, with specific CPT/HCPCS updates.
Watch items
Final_Hospice_Rates_FY_2025_-_Oct_1_2024_-_Sept_30_2025_Compliant_Providers.pdf
The document provides updated Medicaid reimbursement rates for various Ohio counties, detailing specific rates for different types of care services.
Highlights
- •Includes rates for routine home care, continuous home care, inpatient respite care, and general inpatient care.
- •Lists specific rates for Ohio counties such as Adams, Allen, Ashland, and others.
- •Mentions service codes like T2042, T2043, T2044, and T2045.
- •Provides wage index and reimbursement amounts per day or hour.
Reason
The document contains specific reimbursement rates and service codes that are likely to impact billing and policy immediately.
Watch items
CPT_and_HCPCS_level_II_Procedure_code_changes-_2025-04-01.xlsx
The document outlines changes to CPT/HCPCS codes effective April 1, 2025, including new codes and discontinued coverage for certain procedures. It specifies changes in maximum payment amounts and status codes for surgery, medicine, radiology, and evaluation and management services.
Highlights
- •Effective date: April 1, 2025
- •Includes surgery, medicine, radiology, E&M services
- •Status codes indicate new, changed, or discontinued coverage
- •Specific codes like 81433, 81436, 81438 are discontinued
- •New codes include 0527U, 0528U, 0529U, 0530U
Reason
The document contains reimbursement-impacting changes effective soon, including new and discontinued CPT/HCPCS codes.
Watch items
LabServicesPayment_04012025.xlsx
The document outlines revisions to clinical diagnostic and pathology procedures effective April 1, 2025, including changes to maximum payment amounts and discontinued procedure codes.
Highlights
- •Effective date for changes: April 1, 2025
- •Revisions include maximum payment amounts
- •Discontinued procedure codes noted
- •Includes clinical diagnostic and pathology procedures
Reason
The document contains reimbursement-impacting changes effective soon, including rate revisions and discontinued codes.
Watch items
ODM_Dental_CDT_Procedures_1.1.25.pdf
The document outlines significant updates to dental CDT procedure rates effective January 1, 2024, with notable increases in maximum payments for various services.
Highlights
- •New rates effective 01/01/24 for dental procedures.
- •Significant increases in maximum payments for services like oral evaluations and dentures.
- •Example: D0120 increased from $17.08 to $33.56.
- •Example: D5110 increased from $400.00 to $764.40.
Reason
The document contains imminent rate changes that impact reimbursement for dental services.
Watch items
4-1-25_Web_List_with_Cover_Page_and_Previous_Years.pdf
The document from the Ohio Department of Medicaid outlines procedures requiring prior authorization for discharges on or after April 1, 2023. It includes a list of procedure codes that need authorization.
Highlights
- •Procedures requiring prior authorization for discharges from April 1, 2023.
- •Includes a list of specific procedure codes.
- •Document is intended for provider use.
Reason
The document contains new prior authorization requirements effective immediately, impacting reimbursement processes.
Watch items
CPT_and_HCPCS_level_II_Procedure_code_changes-_2026-01-01.xlsx
The document outlines changes to CPT/HCPCS procedure codes effective January 1, 2026, including new codes requiring prior authorization.
Highlights
- •Effective date: January 1, 2026
- •New CPT/HCPCS codes added
- •Prior authorization required for new codes
- •Changes affect surgery, medicine, radiology, and E&M services
Reason
The document includes new procedure codes and prior authorization requirements effective soon, impacting reimbursement.
Watch items
ProviderAdminDrugTable.xlsx
The document outlines updates to the Medicaid fee schedule for vaccines and injectable pharmaceuticals, effective January 1, 2026. It includes changes to coverage and payment rates for specific procedure codes.
Highlights
- •Effective date: January 1, 2026
- •Updates to vaccines and injectable pharmaceuticals
- •Changes in Medicaid maximum payment or coverage status
- •Specific CPT/HCPCS codes referenced
- •Includes historical coverage data
Reason
The document contains upcoming changes to reimbursement rates and coverage, effective soon, impacting provider billing.
Watch items
CPT_and_HCPCS_level_II_Procedure_code_changes-_2024-10-01.xlsx
The document outlines changes to CPT/HCPCS procedure codes effective October 1, 2024, including new codes and payment adjustments for surgery, medicine, radiology, and evaluation and management services.
Highlights
- •Effective date: October 1, 2024
- •Includes surgery, medicine, radiology, and E&M services
- •New CPT/HCPCS codes introduced
- •Changes in maximum payment amounts
- •Discontinued coverage for some codes
Reason
The document details reimbursement-impacting changes effective soon, including new codes and payment adjustments.
Watch items
Rwtables.xlsx
The document provides updated APR DRG relative weight tables for discharges starting from October 1, 2023, through January 1, 2026. It includes specific versions for different discharge periods, indicating a structured update to reimbursement calculations.
Highlights
- •APR DRG v41 for discharges between October 1, 2023, and December 31, 2023.
- •APR DRG v41 for discharges on or after January 1, 2024.
- •APR DRG v42 for discharges on or after October 1, 2024.
- •APR DRG v43 for discharges on or after October 1, 2025.
- •APR DRG v43 for discharges on or after January 1, 2026.
Reason
The document outlines new reimbursement-impacting APR DRG versions effective from October 1, 2023, requiring immediate review.
Watch items
Specialized_Recovery_Services_Program_Fee_Schedule.pdf
The document introduces new rates for specialized recovery services, including IPS-SE and RM services, with effective dates in 2024 and 2025.
Highlights
- •IPS-SE initial rate: $22.02, effective 1/1/2024
- •RM service flat rate: $234.15, effective 8/22/2025
- •RM service managed care rate: $27.54/unit, effective 8/22/2025
Reason
The document specifies new rates and effective dates for Medicaid services, impacting reimbursement.
Watch items
5160-12-08_PH_FF_A_APP1_20211118_1319.pdf
The document updates billing rates for RN assessment and consultation services effective November 1, 2021, with specific rate changes for agency and non-agency providers.
Highlights
- •New rates effective November 1, 2021.
- •RN assessment rate for agency providers: $39.26.
- •RN assessment rate for non-agency providers: $33.57.
- •RN consultation rate for agency providers: $8.83 per 15 minutes.
- •RN consultation rate for non-agency providers: $7.38 per 15 minutes.
Reason
The document includes specific rate changes effective immediately, impacting reimbursement.
Watch items
CPT_and_HCPCS_level_II_Procedure_code_changes-_2025-10-01.xlsx
The document outlines changes to CPT/HCPCS procedure codes effective October 1, 2025, including updates to surgery, medicine, radiology, and evaluation and management services. It specifies changes in maximum payment amounts and discontinued coverage for certain codes.
Highlights
- •Effective date: October 1, 2025
- •Changes in maximum payment amounts
- •Discontinued coverage for some codes
- •Includes surgery, medicine, radiology, and E&M services
Reason
The document contains reimbursement-impacting changes effective soon, including specific rate updates and coverage changes.
Watch items
HospRatesWeb_20260306.xlsx
The document outlines new hospital reimbursement base rates effective January 1, 2026, for inpatient and outpatient services. It includes specific rates for various hospitals and services, indicating a significant update to reimbursement policies.
Highlights
- •Rates effective January 1, 2026.
- •Includes inpatient and outpatient service rates.
- •Lists specific rates for multiple hospitals.
- •Indicates changes in reimbursement policies.
Reason
The document contains specific rate changes effective soon, impacting reimbursement policies.
Watch items
CPT_and_HCPCS_level_II_Procedure_code_changes-_2025-07-01.xlsx
The document outlines changes to CPT/HCPCS procedure codes effective January 1, 2025, including new codes and discontinued coverage for certain services. It specifies changes in maximum payment amounts and status codes for various medical procedures.
Highlights
- •Effective date for changes: January 1, 2025
- •Includes surgery, medicine, radiology, and E&M services
- •Status codes indicate new, changed, or discontinued coverage
- •Specific CPT codes like 81433, 81436, and 81438 are discontinued
- •New codes include 0527U, 0528U, 0529U, 0530U
Reason
The document details reimbursement-impacting changes effective soon, including new and discontinued CPT codes.
Watch items
5160-12-05_PH_FF_A_APP1_20231221_0837.pdf
The document outlines updated Medicaid billing rates for home health services effective January 1, 2024, with specific rate increases for various therapy and nursing services.
Highlights
- •New rates effective January 1, 2024.
- •Increased rates for physical, occupational, and speech therapy.
- •Updated rates for home health aide and nursing services.
- •Comparison with rates from January 1, 2017, to October 31, 2021.
Reason
The document includes specific rate changes effective soon, impacting reimbursement.
Watch items
LabServicesPayment_04012025.pdf
The document outlines updates to clinical diagnostic and pathology procedures, effective April 1, 2025, with revised payment amounts for various procedures.
Highlights
- •Effective date for changes: 04/01/2025
- •Includes clinical diagnostic and pathology procedures
- •Revised maximum payment amounts listed
- •Specific codes like 0037U and 0047U mentioned
Reason
The document includes reimbursement-impacting changes effective soon, with specific payment updates.
Watch items
ERF_213190_DMEPOS_COMBINED_FEE_SCHEDULES_JAN_2026.xlsx
The document outlines a new payment schedule for durable medical equipment effective January 1, 2026, with specific rules on frequency limits and prior authorization requirements.
Highlights
- •New payment schedule effective 01/01/2026.
- •Prior authorization required when frequency limits exceeded.
- •Details on unit amounts and frequency limits provided.
- •Specific HCPCS code mentioned: A4207.
Reason
The document includes a new payment schedule effective soon, impacting reimbursement policies.
Watch items
Final_Hospice_Rates_FY_2025_-_Oct_1_2024_-_Sept_30_2025_Non-Compliant_Providers.pdf
The document provides updated Medicaid reimbursement rates for various Ohio counties, detailing rates for services such as routine home care and inpatient respite care. Specific rates are listed for each county, indicating changes in reimbursement amounts.
Highlights
- •Updated Medicaid rates for Ohio counties.
- •Includes routine home care and inpatient respite care rates.
- •Specific rates provided for each county.
- •CPT codes T2042, T2043, T2044, T2045 mentioned.
Reason
The document contains specific numeric rate changes that impact reimbursement, effective immediately.
Watch items
CPT_and_HCPCS_level_II_Procedure_code_changes-_2024-04-01.xlsx
The document outlines changes to CPT/HCPCS procedure codes effective April 1, 2024, including surgery, medicine, radiology, and evaluation and management services. It also lists genomic and biomarker tests effective January 1, 2024.
Highlights
- •CPT/HCPCS changes effective April 1, 2024.
- •Genomic and biomarker tests effective January 1, 2024.
- •Includes surgery, medicine, radiology, and E&M services.
- •Status codes indicate payment changes or discontinued coverage.
Reason
The document includes upcoming reimbursement-impacting changes effective soon.
Watch items
5160-12-06_PH_FF_A_APP1_20231221_0837.pdf
The document outlines new billing rates for private duty nursing services effective January 1, 2024, with specific rates for agency and non-agency providers.
Highlights
- •Effective date: January 1, 2024
- •New rates for private duty nursing services
- •Includes agency and non-agency RN and LPN rates
- •Overtime rates specified for non-agency providers
Reason
The document specifies new reimbursement rates effective soon, impacting billing and reimbursement.
Watch items
Copy_of_Final_Hospice_Rates_FY_2026_-_Oct_1_2025_-_Sept_30_2026_Non-Compliant_Hospice_Providers.pdf
The document provides updated Medicaid reimbursement rates for various Ohio counties, detailing rates for services such as routine home care and inpatient respite care.
Highlights
- •New rates for Ohio counties including Adams, Allen, and Ashland.
- •Rates cover services like routine home care and inpatient respite care.
- •Specific codes include T2042, G0299/G0155, T2043, T2044, and T2045.
- •Wage index and reimbursement amounts are specified for each county.
Reason
The document contains specific numeric rate changes for Medicaid services, impacting reimbursement immediately.
Watch items
ODM_Dental_CDT_Procedures_1.1.25.xlsx
The document outlines updated Medicaid reimbursement rates for dental CDT procedures effective January 1, 2024. It includes significant increases in maximum payments for various evaluations and imaging services.
Highlights
- •New rates effective 1/1/2024 for dental CDT procedures.
- •Significant rate increases for evaluations and imaging.
- •Includes codes like D0120, D0140, D0150, D0180, D0210.
- •References OAC § 5160-5-01 for additional conditions.
Reason
The document details imminent reimbursement-impacting changes effective January 1, 2024.
Watch items
5160-1-60-_App_DD-_Updates_for_01_01_2026-_FINAL.xlsx
The document outlines changes to the Medicaid non-institutional fee schedule, including updated maximum payment amounts for methadone and buprenorphine/naloxone administration codes effective January 1, 2024.
Highlights
- •New maximum payment amounts for methadone administration codes (H0020) effective 2024-01-01.
- •New maximum payment amounts for buprenorphine/naloxone administration codes (T1502) effective 2024-01-01.
- •Changes affect daily, 7-day, 14-day, 21-day, and 28-day administration codes.
- •Document references Ohio Administrative Code rule 5160-1-60.
Reason
The document includes specific rate changes effective soon, impacting reimbursement.
Watch items
CPT_and_HCPCS_level_II_Procedure_code_changes-_2025-01-01.xlsx
The document outlines changes to CPT/HCPCS procedure codes effective January 1, 2025, including new codes and discontinued coverage for certain services.
Highlights
- •Effective date: January 1, 2025
- •New CPT/HCPCS codes introduced
- •Discontinued coverage for specific codes
- •Changes impact surgery, medicine, radiology, and E&M services
Reason
The document includes reimbursement-impacting changes effective soon, with new and discontinued codes.
Watch items
CPT_and_HCPCS_level_II_Procedure_code_changes-_2024-07-01.xlsx
The document outlines changes to CPT/HCPCS procedure codes effective January 1, 2024, and July 1, 2024, including new tests and changes in maximum payment amounts.
Highlights
- •New CPT/HCPCS procedure code changes effective July 1, 2024.
- •New tests for biomarkers and antibodies effective January 1, 2024.
- •Changes in maximum payment amounts for certain procedures.
- •Discontinued coverage for specific codes effective April 1, 2024.
Reason
The document includes imminent changes to reimbursement rates and coverage, impacting billing and payments.
Watch items
Copy_of_Final_Hospice_Rates_FY_2026_-_Oct_1_2025_-_Sept_30_2026_Compliant_Hospice_Providers.pdf
The document provides updated Medicaid reimbursement rates for various services in Ohio counties, including routine home care, service intensity add-ons, and inpatient care.
Highlights
- •New rates for routine home care, per day, days 1–60 and 61+ (T2042).
- •Service intensity add-on rates per 15 minutes (G0299/G0155).
- •Continuous home care rates per day and per hour (T2043).
- •Inpatient respite care and general inpatient care rates per day (T2044, T2045).
- •Specific rates provided for multiple Ohio counties.
Reason
The document contains specific numeric rate changes for Medicaid services effective immediately, impacting reimbursement.
Watch items
Medium Impact (1)
ASC_Relative_Weights_1-1-26.pdf
The document provides updated ambulatory surgery center (ASC) relative weights effective from January 1, 2026, published on December 30, 2025. It includes specific EAPG relative weights for various codes.
Highlights
- •ASC relative weights effective January 1, 2026
- •Published on December 30, 2025
- •Includes EAPG relative weights for multiple codes
Reason
The changes are not effective immediately, but they are relevant for future reimbursement calculations.
Watch items
Low Impact (1)
5160-59-03$2_PH_FF_N_APP1_20220621_0900.pdf
The document provides a fee schedule for OhioRISE care coordination services effective from July 1, 2022, detailing HCPCS codes and maximum rates for various practitioner types.
Highlights
- •Effective date: July 1, 2022
- •HCPCS code T2023: $1,036.56 for intensive care coordination
- •HCPCS code T2022: $414.44 for moderate care coordination
- •HCPCS code H2000 TG: rates vary by practitioner type
Reason
The document is historical with an effective date over a year ago, indicating low urgency for immediate review.