MedicaidBilling CodesHigh impact
[Indiana] Claim Edits for Durable Medical Equipment
CareSource·IN · Orthopedics, Physical Therapy, Occupational Therapy +5 more·Claims & Billing
Effective date
Jun 10, 2026
We identified it
May 9, 2026
Summary
CareSource is implementing comprehensive claim edits for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) effective June 10, 2026. Billing teams must use correct modifiers (rental, anatomical, functional, and surgical dressing modifiers) for all DMEPOS claims to prevent denials. Additionally, breast pump codes are now limited to one unit per delivery across all providers over a 240-day period.
Action Required
By June 10, 2026: Billing team must implement modifier requirements for all DMEPOS claims submitted to CareSource Indiana (Marketplace and Medicaid). Actions required: (1) Update billing software validation rules to require correct modifier application including rental modifiers (RR), anatomical modifiers (LT, RT), functional modifiers (K0-K4), surgical dressing modifiers (A1-A9, GY), and other required modifiers (KF, KX, GA, GZ); (2) Add system-level edits to prevent billing multiple breast pump codes (E0602, E0603, E0604) per delivery within 240-day windows across all providers in the system; (3) Train billing staff on modifier requirements for each affected category: wheelchairs/accessories, hospital beds, oxygen equipment, respiratory assist devices, orthoses, orthopedic footwear, urological supplies, Class III devices, surgical dressings, and capped rentals; (4) Review and update claim submission templates to include modifier guidance; (5) Establish process to flag claims missing required modifiers before submission. Claims lacking correct modifiers will be denied. Contact CareSource Health Partner Services at 1-833-230-2101 (Marketplace) or 1-844-607-2831 (Medicaid) for questions.