Therapeutic behavioral services, psychosocial rehabilitation, CPST and group services, documented against the treatment plan and billed to Ohio Medicaid from the same record.
Ohio community behavioral health agencies bill TBS (H2019), PSR (H2017) and CPST (H0036) to Ohio Medicaid and its managed care plans under Ohio Administrative Code Chapter 5160-27. Since July 1, 2026, those services need prior authorization once a member passes calendar-year thresholds, and ODM has proposed rule changes for 2026 that would remove CPST and redefine TBS and PSR.
Trustora runs an Ohio Behavioral Health program on the same platform as its Minnesota programs. Services, codes, forms and rules are program configuration, so the Ohio program is kept to Ohio's rules and can change when ODM's final rules do. Clinicians document the service, the record is checked, and the claim is built from what was signed.
Built on the rules
The requirement, where it comes from, and how Trustora handles it. The guides further down explain each rule in detail.
| Requirement | Source | In Trustora |
|---|---|---|
| Prior authorization is required once calendar-year thresholds are reached: TBS and PSR 200 units combined, CPST 200 units, TBS and CPST group 120 units each | ODM bulletin, May 12, 2026 (effective July 1, 2026) | Every service record carries the code, modifier, units and date of service for the member, so the units behind each claim are on the record |
| Group services are billed separately from individual services with the HQ modifier (H2019 HQ, H0036 HQ) | ODM bulletin, May 12, 2026 | Individual and group service records are distinct record types, each with its own code and modifier |
| Behavioral health services must be medically necessary and delivered under the member's assessment and treatment plan | OAC Chapter 5160-27 | Assessments, treatment plans and progress notes live on the client record, and readiness checks run before a service record can become a claim |
| ODM proposed in July 2026 to remove CPST and redefine TBS and PSR (proposed, not final) | ODM stakeholder presentation, July 16, 2026 | Services, codes and forms are program configuration, so the Ohio program definition can be updated when the final rules are filed |
What is included
Client records carry the Ohio Medicaid ID, payers and managed care plans, with assessments, treatment plans and progress notes in one file.
TBS, PSR, CPST and group services are recorded with code, modifier, units and date, linked to the treatment plan they serve.
A service record must pass its checks, such as a signed note and required documents, before it can become a claim.
For psychotherapy services, the CPT code is chosen from the session length, and any override is logged.
837P claims are built from signed service records with NPI and taxonomy, and 277CA acknowledgments and ERA remittances post back automatically.
HIPAA-eligible AWS, AES-256 at rest, TLS 1.3 in transit, a one-time code on every login, and an append-only audit log retained for seven years. BAA included.
FAQ
Guides
Ohio Medicaid behavioral health prior authorization since July 1, 2026: TBS, PSR, CPST, and SUD thresholds, pass-through rules, ODM forms, and 90-day minimum.
Ohio CPST changes in 2026 are still a proposal: ODM floated removing CPST from rule 5160-27-02 and giving TBS and PSR a 200-unit threshold each.
TBS vs PSR in Ohio: OAC 5160-27-08 definitions, who can render H2019 and H2017, group TBS (H2019 HQ), the shared 200-unit threshold, and the 2026 proposal.
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