---
title: CareSource Ohio ABA coverage (Next Gen MCO).
url: "https://carelu.com/payers/caresource-ohio"
markdown_url: "https://carelu.com/payers/caresource-ohio.md"
state: OH (Ohio)
payer: CareSource Ohio
kind: Medicaid managed care plan (MCO)
parent_program: Ohio Medicaid
description: "How CareSource administers Ohio Medicaid ABA under policy MM-0028 — restricted diagnostician specialties, required diagnostic instruments, MUE daily-unit limits, the documentation-before-claims rule, and 6-month reviews."
last_reviewed: September 2026
vob_data_updated: 2026-07-23
---

# CareSource Ohio ABA coverage (Next Gen MCO).

_Payer Guide · CareSource (OH) · Last updated September 2026 · 6 primary sources_

> The strictest OH policy: named diagnostician specialties, ADOS/ADI-R/CARS-2, docs-before-claims.

CareSource is the dominant Ohio Medicaid plan in our data, and its ABA policy (MM-0028, current version effective 9/1/2026 — the prior 7/1/2025 version was archived 8/31/2026) is materially stricter than the state rule: it names which specialties may diagnose, which instruments count, and how many assessment hours are reasonable. As of the 9/1/2026 update, the MUE daily-unit table and the "no documentation, no payment" claims rule now live in a companion reimbursement policy, PY-1638 (same effective date) — the figures are unchanged, they just moved documents. If a family carries CareSource, these two policies are the gate.

This plan administers the **Ohio Medicaid** ABA benefit: the state rules are the floor, and this page covers what the plan layers on top. Read it together with the [Ohio Medicaid guide](https://carelu.com/payers/ohio-medicaid).

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment**: Required — medical-necessity review on all ABA at baseline; assessments capped ~6–10 hrs per 6 months without justification [1]
- **Prior auth for treatment**: Required — 6-month cycles; treatment records must reach CareSource BEFORE claims are accepted [1][2]
- **Autism diagnosis required?**: Yes — ASD from a child/adolescent psychiatrist, psychologist, child neurologist, or developmental pediatrician (ADOS/ADI-R/CARS-2) [1]

## At a glance

- **Plan type:** Ohio Next Generation MCO
- **Policy:** OH MCD-MM-0028 (eff. 9/1/2026), citing MCG B-806-T; + companion reimbursement policy PY-1638 (eff. 9/1/2026)
- **Diagnostician:** Child/adolescent psychiatrist, psychologist, child neurologist, or developmental pediatrician
- **Instruments:** ADOS, ADI-R, or CARS-2; evals >24 months old need a symptom letter
- **Claims rule:** Treatment records BEFORE claims — no docs, no payment
- **Discontinuation:** No meaningful progress across two successive 6-month periods
- **Diagnosis recency:** Eval >24 months old needs a current-symptoms letter

## The diagnosis bar — narrower than the state's

Where the state rule accepts any licensed clinician qualified to diagnose autism, MM-0028 restricts the diagnosis to a child/adolescent psychiatrist, psychologist, child neurologist, or developmental pediatrician, using a standardized instrument — ADOS, ADI-R, or CARS-2. If the evaluation is more than 24 months old, a provider letter documenting DSM symptoms within the past year is required. Screening referral packets against these names and instruments at intake prevents the most common CareSource denial. [1]

## Authorization, units, and the docs-before-claims rule

All ABA services get medical-necessity review at baseline and every 6 months, with continuation requests documenting progress against baseline using the same measurement tools. Behavioral assessments should generally not exceed 6–10 hours per 6-month period without justification. The 9/1/2026 MM-0028 update adds two operational details: a continuation request filed after a temporary break in services (e.g., summer, vacation) must be filed as a continuation, not a new initial request; and progress notes now face more explicit anti-boilerplate requirements — generic, copy-pasted symptom language is no longer sufficient documentation. [1][2][3]

CareSource split its daily-unit and claims-documentation rules out of MM-0028 into a new companion reimbursement policy, PY-1638, effective the same day (9/1/2026) — the prior MM-0028 (eff. 7/1/2025) that carried these rules was archived 8/31/2026. The substance is unchanged, just relocated: daily units still follow the CMS MUE maxima — 97151 at 32, 97153 at 32, 97155 at 24, 97156 at 16 daily units, among others — and the operational standout survives verbatim: treatment records must be submitted to CareSource prior to claim submission — "claims will not be accepted without accompanying treatment documentation." UM runs at (800) 488-0134 via the CareSource Provider Portal. [1][2][3]

Other texture worth knowing: telehealth covers parent training and supervision, with 1:1 ABA via telehealth only when medically necessary under a documented service-delivery plan; and the discontinuation trigger is no meaningful progress across two successive 6-month authorization periods. One rule narrowed in PY-1638: CareSource will no longer reimburse H0036 for ABA whenever a designated ABA CPT code is usable — the older blanket acceptance of H0036 (CPST) billing from certified CBHCs in lieu of ABA CPT codes no longer holds. [1][2][3]

## Intake gates

The questions that decide whether a family can start with CareSource Ohio, and what they have to bring.

- **Diagnosis recency**: CareSource sets the clearest recency rule in Ohio: where the diagnostic evaluation is more than 24 months old, a provider letter documenting DSM symptoms within the past year is required. Continuation requests must document progress against baseline using the same measurement tools, and a request filed after a temporary break in services (summer, vacation) must be filed as a continuation, not a new initial request. [4][1][2][1]
- **Who may diagnose**: Narrower than the state framework: MM-0028 restricts the ASD diagnosis to a child or adolescent psychiatrist, psychologist, child neurologist, or developmental pediatrician — where the state rule accepts any licensed clinician qualified to diagnose autism. Screening referral packets against those four specialties at intake prevents the most common CareSource denial. [4][1][2][1]
- **Diagnostic tools required**: MM-0028 requires the diagnosis to rest on a standardized instrument, and names three: ADOS, ADI-R, or CARS-2. [4][1][2][1]
- **Telehealth**: Telehealth covers parent training and supervision. One-to-one ABA by telehealth is allowed only when medically necessary under a documented service-delivery plan. [4][1][2][1]
- **Prior-auth decision time**: CareSource’s Ohio Medicaid manual matches the rule: “Standard Pre-Service — 7 calendar days from receipt of the request,” with one extension of up to 14 calendar days for lack of information if the member asks. Urgent pre-service decisions come in “48 hours from receipt of request.” No ABA reauthorization lead time is published in the manual. Ohio’s MCO rule sets the clock. For a standard request the MCO “must provide notice to the provider and member as expeditiously as the member’s health condition requires but no later than seven calendar days following receipt of the request for service,” extendable by up to fourteen calendar days (an MCO-requested extension needs ODM’s prior approval). An expedited decision is due “no later than forty-eight hours after receipt of the request for service” (OAC 5160-26-03.1, effective 1/1/2026). The 48 hours is stricter than the federal 72-hour managed-care cap. [7][8]
- **Other insurance (who pays first)**: CareSource coordinates by subtracting “the primary payment from the lessor of the primary carrier allowable or the Medicaid allowable. If the member’s primary insurer pays a provider equal to or more than CareSource’s fee schedule for a covered service, CareSource will not pay the additional amount.” When CareSource is secondary, submit within 365 calendar days of the date of service. If a claim is denied for missing COB information, send the primary payer’s EOB within the rest of the timely-filing period, or within 90 calendar days of the primary EOB date if that period has passed. The manual does not say whether CareSource’s ABA authorization is still needed when a commercial plan pays first. Ohio’s MCO rule: “The MCE is the payer of last resort when a member has third party resources available.” Providers must “take reasonable measures to obtain all third party payments and file claims with all TPPs prior to billing the MCE.” That means a remittance from the other payer showing a valid non-payment reason (service not covered, applied to the deductible or copay, benefit maximum reached), a partial payment with its remittance, or no response within ninety days of submitting to the other payer. The MCO pays at most its allowed amount minus the other payments, and must allow at least ninety days from the other payer’s remittance to file. Exception: “The MCE, except SPBM, pays first for preventive pediatric services before seeking reimbursement from any liable third party.” Children in the custody of a county children’s services agency are exempt from TPL cooperation (OAC 5160-26-09.1). [7][9]
  - Ask the plan: CareSource Provider Services: whether a CareSource ABA authorization is required when a commercial plan pays first.
- **Referral required?** _(ask the plan)_: No Medicaid-side referral or service-order requirement could be verified for this plan or for the state framework. Ohio’s ordering requirement — a psychologist trained in autism, a developmental pediatrician, or a pediatric clinical nurse specialist or certified nurse practitioner — lives in the commercial insurance mandate at R.C. 3923.84, not in Medicaid. [4][1][2]
  - Ask the plan: This plan’s provider portal or behavioral health UM line; Rules@Medicaid.Ohio.gov or JCARR for the in-force text of OAC 5160-34-02.

## Delivery and billing rules

Coverage decides whether CareSource Ohio pays. These decide whether the claim survives: staffing and supervision, concurrent billing, per-day ceilings, who signs the note, where the service is payable, and whose NPI the claim goes out under.

- **Supervision**: Follows the Ohio framework (OAC 4783-6-02: a written supervision plan in each client’s treatment plan, consultation before initiation and modification, periodic direct observation, no fixed ratio). CareSource’s own addition is on records: supervision records must be retained 5 years for COBAs or 7 years for BCBAs and RBTs after supervision ends, and claims tied to documentation discrepancies are subject to recoupment. [4][1][2][1][5]
- **Daily limits / MUEs**: CareSource publishes real per-day maxima, moved from MM-0028 into companion reimbursement policy PY-1638 effective 9/1/2026 with the figures unchanged: daily units follow the CMS MUE maxima — 97151 at 32, 97153 at 32, 97155 at 24 and 97156 at 16 daily units, among others. Behavioral assessments should generally not exceed 6–10 hours per 6-month period without justification, and all ABA carries medical-necessity review at baseline and every 6 months, with discontinuation triggered by no meaningful progress across two successive 6-month authorization periods. [4][1][2][2]
- **Session-note signature**: The operational standout in Ohio: treatment records must be submitted to CareSource prior to claim submission — "claims will not be accepted without accompanying treatment documentation." MM-0028 adds explicit anti-boilerplate requirements on progress notes: generic, copy-pasted symptom language is no longer sufficient documentation. [4][1][2][2][1]
- **Bill as provider**: Follows the Ohio Medicaid framework (COBA or BACB BCBA/BCBA-D as the independent practitioner, ODM Provider Type 19 Specialty 190, BCaBAs and RBTs under supervision; OhioRISE never pays ABA). One rule narrowed in PY-1638: CareSource will no longer reimburse H0036 for ABA whenever a designated ABA CPT code is usable, so the older blanket acceptance of H0036 (CPST) billing from certified CBHCs in lieu of ABA CPT codes no longer holds. [4][1][2][2][6]
- **Concurrent billing (97153 + 97155):** Not published / unverified. Verify via: This plan’s provider portal or behavioral health UM line; Rules@Medicaid.Ohio.gov or JCARR for the in-force text of OAC 5160-34-02. [4][1][2]
- **Place of service** _(ask the plan)_: No plan-specific place-of-service rule found. The confirmed Ohio boundary is the school one: the MCO is not responsible for payment of services provided through the Medicaid School Program under OAC Chapter 5160-35, 5160-35-04 and 5160-26-03. [4][1][2]
  - Ask the plan: This plan’s provider portal or behavioral health UM line; Rules@Medicaid.Ohio.gov or JCARR for the in-force text of OAC 5160-34-02.

## What intake should collect for CareSource Ohio

- **Diagnostician specialty + instrument:** Must be one of the four named specialties using ADOS, ADI-R, or CARS-2 — screen before submission.
- **Evaluation date:** >24 months old triggers the symptom-documentation letter requirement.
- **Documentation pipeline:** Treatment records precede claims — build the handoff so billing never waits on notes.
- **Progress measurement plan:** Continuations must reuse baseline measurement tools — lock them in at the start.

Free verification-call checklist (PDF): https://carelu.com/downloads/aba-verification-call-checklist.pdf

## Verification of benefits (VOB) data

How CareSource Ohio ABA benefits route and read on an eligibility check. Data last updated 2026-07-23.

### EDI routing

- **Payer ID (pVerify):** 01360 — pVerify lists 01360 (CareSource Ohio) and a separate 00776 (CareSource Ohio Medicaid MCE) — confirm which pVerify routes OH Medicaid ABA eligibility through before automating.
- **Supports 270/271 eligibility:** Yes
- **Real-time eligibility:** Yes — Real-time eligibility confirmed via the ODM FI companion guide (whole 270/271 flow); confirm plan-level real-time vs. batch via the clearinghouse.
- **Behavioral health administrator:** none
- **ABA rides on:** medical benefit
- **Two-hop verification required:** No

### Code-level coverage

| Code | Covered | Prior auth | Unit cap | Place of service | Telehealth | Modifiers |
| --- | --- | --- | --- | --- | --- | --- |
| 97151 | Yes — under MM-0028 eff. 9/1/2026 (citing MCG B-806-T); diagnosis restricted to child/adolescent psychiatrist, psychologist, child neurologist, or developmental pediatrician (ADOS/ADI-R/CARS-2) | Required — medical-necessity review at baseline and every 6 months (MM-0028). Distinctive rule, now sited in the companion reimbursement policy PY-1638 (eff. 9/1/2026, same day the prior MM-0028 was archived): treatment documentation must reach CareSource BEFORE claims — "claims will not be accepted without accompanying treatment documentation." UM (800) 488-0134. | 32 units/day (CMS MUE maximum, enumerated in PY-1638, eff. 9/1/2026 — formerly published in MM-0028, figures unchanged) per day | — | Conditional — 1:1 ABA via telehealth only when medically necessary under a documented service-delivery plan (MM-0028); no telehealth modifier/POS number stated. | — |
| 97152 | Yes — under MM-0028 eff. 9/1/2026 (citing MCG B-806-T); diagnosis restricted to child/adolescent psychiatrist, psychologist, child neurologist, or developmental pediatrician (ADOS/ADI-R/CARS-2) | Required — medical-necessity review at baseline and every 6 months (MM-0028). Distinctive rule, now sited in the companion reimbursement policy PY-1638 (eff. 9/1/2026, same day the prior MM-0028 was archived): treatment documentation must reach CareSource BEFORE claims — "claims will not be accepted without accompanying treatment documentation." UM (800) 488-0134. | 16 units/day (CMS MUE maximum, enumerated in PY-1638, eff. 9/1/2026 — formerly published in MM-0028, figures unchanged) per day | — | Conditional — 1:1 ABA via telehealth only when medically necessary under a documented service-delivery plan (MM-0028); no telehealth modifier/POS number stated. | — |
| 97153 | Yes — under MM-0028 eff. 9/1/2026 (citing MCG B-806-T); diagnosis restricted to child/adolescent psychiatrist, psychologist, child neurologist, or developmental pediatrician (ADOS/ADI-R/CARS-2) | Required — medical-necessity review at baseline and every 6 months (MM-0028). Distinctive rule, now sited in the companion reimbursement policy PY-1638 (eff. 9/1/2026, same day the prior MM-0028 was archived): treatment documentation must reach CareSource BEFORE claims — "claims will not be accepted without accompanying treatment documentation." UM (800) 488-0134. | 32 units/day (CMS MUE maximum, enumerated in PY-1638, eff. 9/1/2026 — formerly published in MM-0028, figures unchanged) per day | — | Conditional — 1:1 ABA via telehealth only when medically necessary under a documented service-delivery plan (MM-0028); no telehealth modifier/POS number stated. | — |
| 97154 | Yes — under MM-0028 eff. 9/1/2026 (citing MCG B-806-T); diagnosis restricted to child/adolescent psychiatrist, psychologist, child neurologist, or developmental pediatrician (ADOS/ADI-R/CARS-2) | Required — medical-necessity review at baseline and every 6 months (MM-0028). Distinctive rule, now sited in the companion reimbursement policy PY-1638 (eff. 9/1/2026, same day the prior MM-0028 was archived): treatment documentation must reach CareSource BEFORE claims — "claims will not be accepted without accompanying treatment documentation." UM (800) 488-0134. | 18 units/day (CMS MUE maximum, enumerated in PY-1638, eff. 9/1/2026 — formerly published in MM-0028, figures unchanged) per day | — | Conditional — 1:1 ABA via telehealth only when medically necessary under a documented service-delivery plan (MM-0028); no telehealth modifier/POS number stated. | — |
| 97155 | Yes — under MM-0028 eff. 9/1/2026 (citing MCG B-806-T); diagnosis restricted to child/adolescent psychiatrist, psychologist, child neurologist, or developmental pediatrician (ADOS/ADI-R/CARS-2) | Required — medical-necessity review at baseline and every 6 months (MM-0028). Distinctive rule, now sited in the companion reimbursement policy PY-1638 (eff. 9/1/2026, same day the prior MM-0028 was archived): treatment documentation must reach CareSource BEFORE claims — "claims will not be accepted without accompanying treatment documentation." UM (800) 488-0134. | 24 units/day (CMS MUE maximum, enumerated in PY-1638, eff. 9/1/2026 — formerly published in MM-0028, figures unchanged) per day | — | Conditional — 1:1 ABA via telehealth only when medically necessary under a documented service-delivery plan (MM-0028); no telehealth modifier/POS number stated. | — |
| 97156 | Yes — under MM-0028 eff. 9/1/2026 (citing MCG B-806-T); diagnosis restricted to child/adolescent psychiatrist, psychologist, child neurologist, or developmental pediatrician (ADOS/ADI-R/CARS-2) | Required — medical-necessity review at baseline and every 6 months (MM-0028). Distinctive rule, now sited in the companion reimbursement policy PY-1638 (eff. 9/1/2026, same day the prior MM-0028 was archived): treatment documentation must reach CareSource BEFORE claims — "claims will not be accepted without accompanying treatment documentation." UM (800) 488-0134. | 16 units/day (CMS MUE maximum, enumerated in PY-1638, eff. 9/1/2026 — formerly published in MM-0028, figures unchanged) per day | — | Yes — parent/caregiver training and supervision may be delivered via telehealth per MM-0028 (no specific GT/95 modifier or POS number stated). | — |
| 97157 | Yes — under MM-0028 eff. 9/1/2026 (citing MCG B-806-T); diagnosis restricted to child/adolescent psychiatrist, psychologist, child neurologist, or developmental pediatrician (ADOS/ADI-R/CARS-2) | Required — medical-necessity review at baseline and every 6 months (MM-0028). Distinctive rule, now sited in the companion reimbursement policy PY-1638 (eff. 9/1/2026, same day the prior MM-0028 was archived): treatment documentation must reach CareSource BEFORE claims — "claims will not be accepted without accompanying treatment documentation." UM (800) 488-0134. | 16 units/day (CMS MUE maximum, enumerated in PY-1638, eff. 9/1/2026 — formerly published in MM-0028, figures unchanged) per day | — | Yes — parent/caregiver training and supervision may be delivered via telehealth per MM-0028 (no specific GT/95 modifier or POS number stated). | — |
| 97158 | Yes — under MM-0028 eff. 9/1/2026 (citing MCG B-806-T); diagnosis restricted to child/adolescent psychiatrist, psychologist, child neurologist, or developmental pediatrician (ADOS/ADI-R/CARS-2) | Required — medical-necessity review at baseline and every 6 months (MM-0028). Distinctive rule, now sited in the companion reimbursement policy PY-1638 (eff. 9/1/2026, same day the prior MM-0028 was archived): treatment documentation must reach CareSource BEFORE claims — "claims will not be accepted without accompanying treatment documentation." UM (800) 488-0134. | 16 units/day (CMS MUE maximum, enumerated in PY-1638, eff. 9/1/2026 — formerly published in MM-0028, figures unchanged) per day | — | Conditional — 1:1 ABA via telehealth only when medically necessary under a documented service-delivery plan (MM-0028); no telehealth modifier/POS number stated. | — |
| 0362T | Yes — under MM-0028 eff. 9/1/2026 (citing MCG B-806-T); diagnosis restricted to child/adolescent psychiatrist, psychologist, child neurologist, or developmental pediatrician (ADOS/ADI-R/CARS-2) | Required — medical-necessity review at baseline and every 6 months (MM-0028). Distinctive rule, now sited in the companion reimbursement policy PY-1638 (eff. 9/1/2026, same day the prior MM-0028 was archived): treatment documentation must reach CareSource BEFORE claims — "claims will not be accepted without accompanying treatment documentation." UM (800) 488-0134. | 16 units/day (CMS MUE maximum, enumerated in PY-1638, eff. 9/1/2026 — formerly published in MM-0028, figures unchanged) per day | — | Conditional — 1:1 ABA via telehealth only when medically necessary under a documented service-delivery plan (MM-0028); no telehealth modifier/POS number stated. | — |
| 0373T | Yes — under MM-0028 eff. 9/1/2026 (citing MCG B-806-T); diagnosis restricted to child/adolescent psychiatrist, psychologist, child neurologist, or developmental pediatrician (ADOS/ADI-R/CARS-2) | Required — medical-necessity review at baseline and every 6 months (MM-0028). Distinctive rule, now sited in the companion reimbursement policy PY-1638 (eff. 9/1/2026, same day the prior MM-0028 was archived): treatment documentation must reach CareSource BEFORE claims — "claims will not be accepted without accompanying treatment documentation." UM (800) 488-0134. | 32 units/day (CMS MUE maximum, enumerated in PY-1638, eff. 9/1/2026 — formerly published in MM-0028, figures unchanged) per day | — | Conditional — 1:1 ABA via telehealth only when medically necessary under a documented service-delivery plan (MM-0028); no telehealth modifier/POS number stated. | — |

Code notes:

- **97151, 97152, 97153, 97154, 97155, 97156, 97157, 97158, 0362T, 0373T:** Assessments generally 6-10 hrs per 6 months without justification (MM-0028); discontinuation trigger is no meaningful progress across two successive 6-month periods (MM-0028); RBT supervision >=5% of monthly ABA hours (MM-0028). PY-1638 (eff. 9/1/2026) narrows the old H0036 rule: CareSource will no longer reimburse H0036 for ABA when a designated ABA CPT code is usable — the prior blanket acceptance of H0036 (CPST) billing from certified CBHCs in lieu of ABA CPT codes no longer holds. The 9/1/2026 MM-0028 also requires continuation requests filed after a temporary break in services (e.g., summer, vacation) to be submitted as continuations, not new initial requests, and adds explicit anti-boilerplate requirements for symptom documentation in progress notes. Verify POS/telehealth modifier mechanics via the CareSource provider portal.

### Contacts

- **Provider services phone:** (800) 488-0134
- **Portal:** [CareSource Provider Portal](https://providerportal.caresource.com/OH/User/Login.aspx)

Questions to ask on a verification call:

- What POS code should we use for home-based vs. clinic-based ABA sessions?
- Is there a specific telehealth modifier (e.g., GT/95) required when billing parent-training/supervision or 1:1 ABA delivered via telehealth?

### VOB data sources

- https://pverify.com/wp-content/uploads/2026/03/pVerifyPayers_All-Payers-List-3-2026.pdf (accessed 2026-07-23)
- https://dam.assets.ohio.gov/image/upload/medicaid.ohio.gov/Providers/MITS/HIPAA%205010%20Implementation/CompanionGuide/OMES/FFS/Ohio270-271.pdf (accessed 2026-07-23)
- https://www.caresource.com/documents/medicaid-oh-policy-medical-mm-0028-20260901 (accessed 2026-09-01)
- https://www.caqh.org/sites/default/files/CAQH%20CORE%20Eligibility%20Benefits%20(270_271)%20Data%20Content%20Rule%20vEB2.0.pdf (accessed 2026-07-23)
- https://www.caresource.com/documents/medicaid-oh-policy-reimburse-py-1638-20260901 (accessed 2026-09-01)
- https://www.caresource.com/documents/ohio-medicaid-prior-authorization-list/ (accessed 2026-07-23)
- https://providerportal.caresource.com/ (accessed 2026-07-23)

## Common questions

### Does CareSource Ohio cover ABA therapy?

Yes — under policy MM-0028 (eff. 9/1/2026) plus its companion reimbursement policy PY-1638, with medical-necessity review on all ABA at baseline and every 6 months. Its requirements are stricter than the state rule on diagnostician specialty, instruments, and documentation.

### Who can diagnose autism for CareSource Ohio ABA?

A child/adolescent psychiatrist, psychologist, child neurologist, or developmental pediatrician, using ADOS, ADI-R, or CARS-2 — narrower than the state baseline.

### Why did CareSource reject our claim?

A distinctive rule, now sited in reimbursement policy PY-1638: treatment documentation must be submitted before claims. Claims without accompanying treatment records are not accepted — check the documentation pipeline first.

### Does CareSource Ohio still accept H0036 in lieu of ABA CPT codes?

Not as a blanket rule anymore. As of PY-1638 (eff. 9/1/2026), CareSource will not reimburse H0036 for ABA when a designated ABA CPT code is usable — confirm which code applies before billing.

## Primary sources

1. [CareSource — OH MCD-MM-0028 (eff. 9/1/2026)](https://www.caresource.com/documents/medicaid-oh-policy-medical-mm-0028-20260901)
2. [CareSource — OH MCD reimbursement policy PY-1638 (eff. 9/1/2026)](https://www.caresource.com/documents/medicaid-oh-policy-reimburse-py-1638-20260901)
3. [CareSource — Ohio Medicaid prior authorization list](https://www.caresource.com/documents/ohio-medicaid-prior-authorization-list/)
4. [Ohio Administrative Code — rule 5160-34-02](https://codes.ohio.gov/ohio-administrative-code/rule-5160-34-02)
5. [Ohio Administrative Code — rule 4783-6-02 (COBA supervision responsibilities)](https://www.law.cornell.edu/regulations/ohio/Ohio-Admin-Code-4783-6-02)
6. [ODM — OhioRISE Mixed Services Protocol (4/1/2025)](https://dam.assets.ohio.gov/image/upload/v1743449666/managedcare.medicaid.ohio.gov/OhioRISE/OhioRISE_Mixed_Services_Protocol_20250401.pdf)
7. [CareSource — Ohio Medicaid Provider Manual](https://www.caresource.com/documents/oh-provider-manual.pdf)
8. [OAC 5160-26-03.1 — MCO utilization management and authorization timeframes (eff. 1/1/2026)](https://codes.ohio.gov/ohio-administrative-code/rule-5160-26-03.1)
9. [OAC 5160-26-09.1 — MCO third party recovery and coordination of benefits](https://codes.ohio.gov/ohio-administrative-code/rule-5160-26-09.1)

Payer policies change frequently and vary by plan, state, and funding type. This guide was compiled from the sources above and last reviewed September 2026; it is general information, not billing, legal, or clinical advice. Always verify current requirements against the payer's live policy and a benefits check for the specific member.

Source: Carelu ABA Payer Directory — https://carelu.com/payers. Free to cite with attribution.