MedicaidReimbursementMedium impact
[Indiana] October 2025 Policy Updates
CareSource·IN·Medical Policy
Effective date
Dec 1, 2025
We identified it
May 9, 2026
Summary
CareSource Indiana Medicaid is updating reimbursement policies for modifier usage effective December 1, 2025. Two policies are being revised: Modifier 59 (with variants XE, XP, XS, XU) and Modifier 25, which impact how billing teams append modifiers to claims for Indiana Medicaid members.
Action Required
By November 30, 2025: Billing team must review and implement the revised Modifier 59 (PY-1366) and Modifier 25 (PY-1362) policies on CareSource.com. Access the full policy text through Provider Tools & Resources > Provider Policies, select Indiana Medicaid plan. Update billing software and encoder logic to ensure correct modifier appending per the December 1 effective date. Compare revised policies against archived versions to identify specific changes to modifier usage rules. Document changes in billing procedures and communicate updates to all billing staff and providers. Failure to implement correct modifiers may result in claim denials or payment adjustments.