MedicaidReimbursementHigh impact
[Indiana] July 2026 Policy Updates
CareSource·IN · Dentistry, Pediatrics·Medical Policy
Effective date
Sep 1, 2026
We identified it
Jul 1, 2026
Summary
CareSource Indiana Medicaid released four policy updates effective September 1, 2026, including revisions to modifier usage (Modifier 25 and modifiers 59/XE/XP/XS/XU), dental services billing in facility settings, and infant formula coverage. The billing team must review each policy detail on CareSource.com to understand specific reimbursement rule changes before the effective date.
Action Required
By August 31, 2026: Billing team must access and review all four revised policies on CareSource.com (Providers > Tools & Resources > Provider Policies > Indiana Medicaid). Specifically: (1) Review PY-1362 (Modifier 25) revision to understand updated bundling and billing rules; (2) Review PY-1366 (Modifier 59, XE, XP, XS, XU) revision to understand which modifiers apply to which scenarios; (3) Review PY-1304 (Dental Services in Outpatient/ASC) to determine which dental procedures can be billed in facility settings; (4) Review MM-1357 (Infant Formula) to confirm covered formula types and billing requirements. Update billing software rules, encounter forms, and provider education materials accordingly. Compare revised policies to previous versions on archived webpages to identify specific changes. Failure to implement changes by September 1 will result in claim denials for non-compliant submissions.