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Ohio Department of Medicaid Updates: Key Changes to Physician Reimbursement Rates in Early Parenthood

Client Alert
December 3, 2025

The Ohio Department of Medicaid (ODM) has proposed amending Ohio Administrative Code Rule 5160-1-60 related to covered Medicaid reimbursements for physicians. At a hearing held November 14, 2025, ODM received no comments on its proposed changes. Beginning on January 1, 2026, ODM is proposing an increase to rates for prenatal care, childbirth, and infant care and provider visits.

The following services are proposed to have increased max payments or will be covered for the first time:

  • H1000 TH* Prenatal care: at risk assessment ea addl (NEW)
  • H1001 Prenatal care: antepartum management
  • H1002 Prenatal care: care coordination
  • H1003 Prenatal care: individual education
  • S9452 Prenatal nutrition classes, non-physician
  • S9436 Childbirth prep/Lamaze classes, non-physician
  • S9437 Childbirth refresher classes, non-physician
  • S9444 Baby parenting classes, non-physician
  • S6127 Brief emotional/behave assmt
  • 99202 TH* Pre-natal office/outpatient visit, new
  • 99211 TH* Pre-natal office/outpatient visit, est
  • 99212 TH* Pre-natal Office/outpatient visit, est
  • 99213 TH* Pre-natal office/outpatient visit, est
  • 99381 Preventive visit, new, infant
  • 99382 Preventive visit, new, 1-4 yrs old
  • 99391 Preventive visit, estab, infant
  • 99392 Preventive visit, estab, 1-4 yrs old

To learn more about the proposed changes and updated Medicaid payment reimbursements, please contact BMD Healthcare Member Daphne Kackloudis at dlkackloudis@bmdllc.com or Attorney Jordan Burdick at jaburdick@bmdllc.com.

Ohio Department of MedicaidHealth Law
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