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CareSourceMedicaid · Billing Codes · Claims & Billing · IN · Orthopedics, Physical Therapy, Occupational Therapy +5 moreHigh impact

[Indiana] Claim Edits for Durable Medical Equipment

Act
by Jun 10, 2026
Effective date
Jun 10, 2026
Identified
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.

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What to do

by Jun 10, 2026 · 8 steps
01Billing team must implement modifier requirements for all DMEPOS claims submitted to CareSource Indiana (Marketplace and Medicaid).
02Update 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).
03Add 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.
04Train 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.
05Review and update claim submission templates to include modifier guidance.
06Establish process to flag claims missing required modifiers before submission.
07Claims lacking correct modifiers will be denied.
08Contact CareSource Health Partner Services at 1-833-230-2101 (Marketplace) or 1-844-607-2831 (Medicaid) for questions.

Codes mentioned

E0602E0603E0604

Original notice

[Indiana] Claim Edits for Durable Medical Equipment
caresource.com · Always check the source before changing claims.
View original ↗

Related changes

See all CareSource changes →
[Ohio] Claim Edits for Durable Medical EquipmentHighEffective Jan 15, 2026 · Claims & Billing[Georgia] Claim Edits for Durable Medical EquipmentHighEffective Jan 17, 2026 · Claims & BillingBrowse every CareSource change in the policy list

Related policy hubs

CareSource policiesIN policy changesOrthopedicsPhysical TherapyOccupational TherapyPodiatryWound CareUrologyPulmonologyPM&R (Physical Medicine & Rehab)Code E0602Code E0603Code E0604

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