MedicaidBilling CodesHigh impact
BT202627: IHCP announces changes to applied behavior analysis (ABA) therapy services
Indiana Medicaid (IHCP)·IN · Psychiatry·Specialty Services
Effective date
Apr 1, 2026
We identified it
Jun 18, 2026
Summary
Indiana Medicaid is implementing major changes to ABA therapy services effective April 1, 2026, including restricting coverage to members under 21, expanding eligible providers for CPT 97153, implementing rate reductions, adding new modifiers for group services and comprehensive therapy, and establishing a 4,000-hour lifetime limit for comprehensive ABA therapy.
Action Required
By April 1, 2026: Billing team must update system to use new modifiers U1, U2, U3 for individual ABA services based on provider credentials, and U4, U6, U8 for group services based on group size. Add modifier UA for comprehensive ABA therapy services. Update fee schedules with new reduced rates (6% reduction for individual services). Implement age restrictions - members 21+ can only receive services through September 30, 2026. Enroll providers under correct specialty codes (615, 624, 625). Claims without proper modifiers will be denied.