MedicaidBilling CodesMedium impact
[Indiana] Prothesis and Orthosis Claims Editing Logic
CareSource·IN · Orthopedics, PM&R (Physical Medicine & Rehab), Physical Therapy·Provider Bulletin
Effective date
Jul 24, 2025
We identified it
May 9, 2026
Summary
Effective July 24, 2025, CareSource Indiana Medicaid and Marketplace plans require prosthetics and orthotics that can be billed bilaterally to include anatomic modifiers (LT for left, RT for right). Claims processed after this date without appropriate modifiers will be subject to new claims editing logic aligned with CMS payment policies.
Action Required
By July 24, 2025: Billing team must update claims submission processes to require anatomic modifiers (LT and RT) on all bilateral prosthetic and orthotic claims submitted to CareSource Indiana Medicaid and Marketplace plans. Update billing software validation rules to flag prosthetic/orthotic claims missing appropriate laterality modifiers before submission. Train billing staff and providers on modifier requirements. Notify providers to include modifiers on orders and documentation. Claims submitted without proper modifiers after the effective date will be edited by CareSource's new logic and may be subject to denial or adjustment.