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BT202675: IHCP announces clarifications to the policies and billing procedures for the CCBHC program
Effective date
Feb 1, 2026
Identified
Jun 18, 2026
Summary
Effective February 1, 2026, the Indiana Health Coverage Programs (IHCP) clarified Certified Community Behavioral Health Clinic (CCBHC) pilot program billing policies. CMHC and CCBHC providers may not bill the same procedure code for the same member on the same date of service, subject to limited exceptions, and the bulletin also covers ACT billing, audio-only telehealth limits, other insurance claim detail and benefit periods for MRO level of need 4. The bulletin's correction changes the EOB code for denial of services not authorized as audio-only to 6788.
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What to do
Action · 17 steps
01Already effective February 1, 2026: CMHC billing team, do not bill the same procedure code for the same member on the same date of service as a CCBHC.
02If a CMHC claim is submitted after a CCBHC claim for the same service, member and date has been paid, the CMHC detail is denied with EOB 6356, and if the CMHC claim was paid first, the paid CMHC detail is recouped with EOB 6357.
03For the exceptions, bill CCBHC services with the CCBHC NPI, bill crisis services at a CMHC location with the CMHC NPI unless the CMHC is also enrolled as a CCBHC, and bill school-based CMHC services outside the CCBHC designated service area with the CMHC NPI.
04Add the XE modifier to the CMHC claims only for these exceptions.
05CCBHC billing team, bill ACT services with the V4 modifier instead of Q2, along with the appropriate procedure code.
06H0039 has been removed from the CCBHC valid encounter (triggerable) code list; bill H0039 as nontriggerable only when no code accurately describes the ACT service, and include at least one code from the CCBHC valid encounter code list for the claim to be reimbursable.
07Bill T1007 or T1016 without modifier 93 for face-to-face services to receive the PPS payment.
08Claims for T1007 or T1016 billed with modifier 93 are denied with EOB 6788 unless another triggerable service and the T1040 are also billed.
09Do not include modifiers HL or HE on CCBHC claims for services by interns or qualifying practitioners billed under a supervisor's NPI, and document in the chart that the service was provided by an intern or qualifying practitioner under supervision.
10For Package E (emergency services only) members, bill only emergency services, and for Package B members, bill only emergency or prenatal/postpartum services.
11For dates of service on or after February 1, 2026, T2022 Q2 U1 can be billed with T1040.
12For dually eligible members with Medicare or a Medicare Advantage plan and full Medicaid, submit the Medicare payment, deductible, copayment and coinsurance information on the T1040 detail, and do not submit Medicare payments on the valid encounter details.
13For members with only QMB-Only or SLMB-Only coverage, do not submit T1040.
14For members with commercial TPL, include T1040 with all encounter services and report TPL at each detail level, summing to the claim header amounts.
15For MRO level of need 4 services, request prior authorization only for units above the adult or child LON 4 MRO package thresholds, because the claim-processing system looks back 180 rolling calendar days from the date of service and a claim that exceeds the threshold without PA will deny.
16CCBHCs do not need to create MRO packages through the DARMHA database.
17Direct questions to your Provider Relations consultant or to Customer Assistance at 800-457-4584.
Codes mentioned
T1040T2022T1007T1016H00399800090832
Original notice
BT202675: IHCP announces clarifications to the policies and billing procedures for the CCBHC program
in.gov · Always check the source before changing claims.
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