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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
Client Alert

Ohio Recovery Housing (ORH) Repairs Fund Application Open for Eligible Applicants

April 14, 2023The Ohio Recovery Housing (ORH) Repairs Fund Application is open for eligible organizations and/or operators of recovery housing facilities throughout the state of Ohio!Multimedia, Client Alert

Pregnant Employee Protections - New Requirements for Employers

April 11, 2023New protections are coming to the workplace for pregnant employees in 2023! In the most sweeping changes since the Pregnancy Discrimination Act of 1978, two new federal laws were recently passed: (1) the PUMP for Nursing Mothers Act (otherwise known as the Pump Act), and (2) the Pregnant Workers Fairness Act. The requirements of these statutes will require employers with more than 15 employees to implement new policies for their handbooks.Client Alert

Five Common Pitfalls for Employers to Watch Out for Under the Fair Labor Standards Act

March 29, 2023The Fair Labor Standards Act (FLSA) sets forth requirements for employers including, but not limited to, minimum wage, overtime pay, and recordkeeping for covered employees. These requirements are not as simple as they may appear on their face, which leads many employers to fall into compliance issues that they did not realize even existed.Client Alert

The NLRB Limits the Reach of Confidentiality and Non-Disparagement Provisions in Severance Agreements Overruling Trump-Era Policies

March 14, 2023Employers should exercise caution and closely examine the content of severance agreements to ensure compliance with a recent National Labor Relations Board (“NLRB”) decision.  On February 21, 2023, the NLRB restricted the breadth of permissible language of confidentiality and non-disparagement clauses when it issued its decision in McLaren Macomb and overruled its Trump-era decisions in Baylor University Medical Center and IGT d/b/a International Game Technology.Client Alert

Ohio Medical Board Releases New Telehealth Rules

February 23, 2023On Tuesday, February 21, 2023, the State Medical Board of Ohio released its final telehealth rules to implement Ohio’s telehealth statute (O.R.C. 4743.09) for physicians, physician assistants, dieticians, respiratory care professionals and genetic counselors. Ohio’s advanced practice registered nurses (“APRNs”) should also take note of these rules. While the Medical Board does not govern APRNs directly, those APRNs who are required to have a collaborating physician and standard care arrangement (namely nurse practitioners, certified nurse midwives, and clinical nurse specialists) are still affected by the rules. Generally, if an APRN’s collaborating physician is limited in their practice, then the APRN will also be limited.
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