MedicaidReimbursementHigh impact
BT2026121: IHCP announces rate changes for PRTF DCS placements
Indiana Medicaid (IHCP)·IN · Psychiatry, Pediatrics·Reimbursement
Effective date
Jul 1, 2026
We identified it
Jul 28, 2026
Summary
Indiana Health Coverage Programs (IHCP) has increased DCS wraparound payment rates for psychiatric rehabilitation treatment facilities (PRTFs) effective July 1, 2026. Billing teams must immediately update all July 2026 and forward claims for DCS-placed youth to use the new rates; any July claims submitted with old rates must be corrected and resubmitted to Gainwell. The policy reinforces mandatory use of specific procedure-code-and-modifier combinations for DCS placements.
Action Required
IMMEDIATE ACTION REQUIRED: By July 31, 2026, billing team must (1) obtain the 2026 DCS wraparound rate letter from Department of Child Services and update all billing system rates for PRTF services; (2) ensure all July 2026 claims for DCS-placed youth are submitted using the correct new rate with proper modifiers (T2048 U3 for regular per diem, T2048 U3 U1 for medical leave, T2048 U3 U2 for therapeutic leave); (3) identify and correct any July 2026 claims already submitted with old rates by resubmitting them to Gainwell with the new rate information; (4) audit all DCS placement billing records to verify proper code-modifier combinations are being used. PRTF billing staff must verify rate updates in system before processing any July claims. Failure to use correct rates will result in underpayment or claim denials requiring manual correction and resubmission.