MedicaidBilling CodesHigh impact
[Indiana] Concurrent Billing of 97153
CareSource·IN · Psychiatry, Speech Therapy, Occupational Therapy·Claims & Billing
Effective date
Jan 5, 2026
We identified it
May 9, 2026
Summary
CareSource Indiana Medicaid and Marketplace plans prohibit concurrent billing of CPT 97153 (adaptive behavior treatment) with other direct services like occupational therapy or speech therapy during overlapping time blocks. CPT 97155 may be billed concurrently with technician-delivered 97153 services only when protocols are modified and a QHP is directing. Services must be delivered in separate, sequential time blocks to be billable on the same day.
Action Required
By January 5, 2026 (immediately): (1) Billing team must update billing software and claim submission rules to prevent concurrent billing of CPT 97153 with CPT codes for speech therapy, occupational therapy, or other direct services during overlapping time periods. (2) Providers and clinical staff must document clear start and stop times for all ABA and ancillary therapy sessions in the EMR and on encounter forms. (3) Implement a verification workflow to confirm services are delivered in separate, sequential time blocks before claim submission. (4) Train all ABA providers, RBTs, and QHPs on the concurrent billing restrictions and the exception allowing CPT 97155 with technician-delivered 97153 only when a QHP is directing and modifying protocols. (5) Update prior authorization request templates to require start/stop times for each service. Failure to comply may result in claim denials and referral to CareSource Program Integrity for investigation of fraud, waste, or abuse.