MedicaidBilling CodesHigh impact
[Indiana] Claims Editing – Add-On Codes, E/M and Special Services
CareSource·IN·Provider Bulletin
Effective date
Mar 2, 2026
We identified it
May 9, 2026
Summary
CareSource is implementing enhanced claims editing rules effective March 2, 2026, for Indiana Marketplace and Medicaid plans. Key changes include: (1) add-on codes will be denied if the primary code is missing or denied, (2) only one E/M code per date of service per provider group/specialty is allowed (with modifier exceptions), and (3) special service codes 99050 and 99051 are restricted to office settings only.
Action Required
By March 2, 2026: Billing team must implement system edits to enforce these three rules: (1) Configure billing software to automatically deny add-on codes when primary codes are absent or denied—audit all historical add-on code claims for recurrence patterns; (2) Update E/M billing logic to allow only one E/M code per date of service per provider group/specialty, with system alerts when multiple E/M codes are submitted (ensure modifiers are properly documented for legitimate exceptions); (3) Add claim edit to reject CPT 99050 and 99051 if billed in non-office settings and route to providers with guidance on correct code usage. Providers and billing staff must be trained on these changes. Before effective date, conduct a test run on sample claims to verify system edits are functioning correctly. After March 2, 2026, monitor claim denials related to these edits and contact CareSource Health Partner Services (Marketplace: 1-833-230-2101 or Medicaid: 1-844-607-2831) for clarification on any borderline cases. Failure to implement these edits will result in increased claim denials and revenue loss.